Healthcare Provider Details

I. General information

NPI: 1033448345
Provider Name (Legal Business Name): RENAE MOREL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2969 CURRAN DR N BLDG A
JACKSON MS
39216-4121
US

IV. Provider business mailing address

113 CAMELLIA CIR
FLORENCE MS
39073-8632
US

V. Phone/Fax

Practice location:
  • Phone: 601-714-8141
  • Fax:
Mailing address:
  • Phone: 719-285-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number905886
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0010152NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number905886
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: