Healthcare Provider Details

I. General information

NPI: 1568554582
Provider Name (Legal Business Name): JULIE VANSICE CFNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 LAKELAND DR ST. THOMAS HALL
JACKSON MS
39216-4606
US

IV. Provider business mailing address

PO BOX 23666
JACKSON MS
39225-3666
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-3110
  • Fax: 601-200-3109
Mailing address:
  • Phone: 601-200-3110
  • Fax: 601-200-3109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR710539
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: