Healthcare Provider Details

I. General information

NPI: 1346652377
Provider Name (Legal Business Name): RACHEL NICHOLE FORD WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2014
Last Update Date: 05/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5963 I 55 N
JACKSON MS
39213-9722
US

IV. Provider business mailing address

104 COTTONWOOD CIR
BRANDON MS
39047-6241
US

V. Phone/Fax

Practice location:
  • Phone: 601-978-7864
  • Fax:
Mailing address:
  • Phone: 601-832-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR878927
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: