Healthcare Provider Details

I. General information

NPI: 1154241578
Provider Name (Legal Business Name): ELIZABETH JOACHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 KATHERINE DR
FLOWOOD MS
39232-9588
US

IV. Provider business mailing address

PO BOX 102
OCEAN SPRINGS MS
39566-0102
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax:
Mailing address:
  • Phone: 228-327-7000
  • Fax: 228-215-0619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908423
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: