Healthcare Provider Details

I. General information

NPI: 1366837767
Provider Name (Legal Business Name): ADVANCE HEALTHCARE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E RAILROAD ST
LONG BEACH MS
39560-4918
US

IV. Provider business mailing address

PO BOX 37
LONG BEACH MS
39560-0037
US

V. Phone/Fax

Practice location:
  • Phone: 228-297-5597
  • Fax:
Mailing address:
  • Phone: 228-297-5597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRENITA L MOORE
Title or Position: DIRECTOR
Credential: FNP-BC
Phone: 228-297-5597