Healthcare Provider Details

I. General information

NPI: 1104077767
Provider Name (Legal Business Name): KAREN PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 HOLMES PITTMAN RD
FOXWORTH MS
39483-3166
US

IV. Provider business mailing address

285 HOLMES PITTMAN RD
FOXWORTH MS
39483-3166
US

V. Phone/Fax

Practice location:
  • Phone: 601-441-9821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number179391
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: