Healthcare Provider Details

I. General information

NPI: 1326462581
Provider Name (Legal Business Name): BETH FELDER, MD. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2014
Last Update Date: 02/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 COLLEGE DR
HATTIESBURG MS
39406-0002
US

IV. Provider business mailing address

27 DEER VLY
HATTIESBURG MS
39402-5503
US

V. Phone/Fax

Practice location:
  • Phone: 601-266-5163
  • Fax: 601-266-5850
Mailing address:
  • Phone: 601-264-2970
  • Fax: 601-266-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13567
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT0049
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR858140
License Number StateMS

VIII. Authorized Official

Name: DR. ELIZABETH M FELDER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 601-266-5163