Healthcare Provider Details

I. General information

NPI: 1164663936
Provider Name (Legal Business Name): MRS. CHRISTIE ANN THRASH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIE ANN LADNER CPNP

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 SPRING ST SUITE A
GULFPORT MS
39507-3423
US

IV. Provider business mailing address

2500 NORTH STATE STREET JMM SUITE 2525
JACKSON MS
39216-3921
US

V. Phone/Fax

Practice location:
  • Phone: 228-896-6441
  • Fax: 228-896-6576
Mailing address:
  • Phone: 601-815-9528
  • Fax: 601-984-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR790578
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: