Healthcare Provider Details

I. General information

NPI: 1306057252
Provider Name (Legal Business Name): GAIL DAVIS WELDY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 LEAF LN
HATTIESBURG MS
39402-9549
US

IV. Provider business mailing address

PO BOX 609
PURVIS MS
39475-0609
US

V. Phone/Fax

Practice location:
  • Phone: 601-264-9764
  • Fax: 601-216-3393
Mailing address:
  • Phone: 601-794-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR863898
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: