Healthcare Provider Details

I. General information

NPI: 1336735323
Provider Name (Legal Business Name): THE PRUDENT NURSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 VILLAGE GREEN CIR
JACKSON MS
39211-2931
US

IV. Provider business mailing address

35 VILLAGE GREEN CIR
JACKSON MS
39211-2931
US

V. Phone/Fax

Practice location:
  • Phone: 601-573-7833
  • Fax:
Mailing address:
  • Phone: 601-573-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL TUCKER
Title or Position: MANAGING PARTNER
Credential: RN
Phone: 601-573-7833