Healthcare Provider Details

I. General information

NPI: 1477220614
Provider Name (Legal Business Name): CHRISTY DUVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15120 COUNTY BARN RD
GULFPORT MS
39503-4263
US

IV. Provider business mailing address

PO BOX 18679
HATTIESBURG MS
39404-8679
US

V. Phone/Fax

Practice location:
  • Phone: 228-213-3900
  • Fax: 228-575-6295
Mailing address:
  • Phone: 601-705-1901
  • Fax: 601-705-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number881791
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: