Healthcare Provider Details

I. General information

NPI: 1366756678
Provider Name (Legal Business Name): PATRICE MURRAY BUISSON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 RIVER OAKS DR STE 304
FLOWOOD MS
39232-9575
US

IV. Provider business mailing address

1040 RIVER OAKS DR STE 304
FLOWOOD MS
39232-9575
US

V. Phone/Fax

Practice location:
  • Phone: 601-936-1170
  • Fax: 601-936-1331
Mailing address:
  • Phone: 601-936-1170
  • Fax: 601-936-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberD1045
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: