Healthcare Provider Details

I. General information

NPI: 1700594322
Provider Name (Legal Business Name): CHRISTINA GILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 07/08/2023
Certification Date: 07/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HIGHWAY 35 S
FOREST MS
39074-4000
US

IV. Provider business mailing address

1061 HIGHWAY 35 S
FOREST MS
39074-4000
US

V. Phone/Fax

Practice location:
  • Phone: 601-541-4313
  • Fax: 601-541-4314
Mailing address:
  • Phone: 601-541-4313
  • Fax: 601-541-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number894849
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905462
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: