Healthcare Provider Details

I. General information

NPI: 1770068637
Provider Name (Legal Business Name): HAPPY FEET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 CHIPPEWAH DR
LAUREL MS
39443
US

IV. Provider business mailing address

614 CHIPPEWAH DR
LAUREL MS
39443
US

V. Phone/Fax

Practice location:
  • Phone: 601-323-7433
  • Fax: 601-422-0727
Mailing address:
  • Phone: 601-323-7433
  • Fax: 601-422-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SC2300X
TaxonomyChronic Care Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELE E MILLSAP
Title or Position: OWNER
Credential: RN, CDFS, CTBN,CTTS
Phone: 601-323-7433