Healthcare Provider Details

I. General information

NPI: 1205747870
Provider Name (Legal Business Name): RANDY R HOOKS REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 FULLER RD BLDG 367
MERIDIAN MS
39309-5106
US

IV. Provider business mailing address

1801 FULLER RD BLDG 367
MERIDIAN MS
39309-5106
US

V. Phone/Fax

Practice location:
  • Phone: 601-679-3972
  • Fax:
Mailing address:
  • Phone: 601-679-3972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberR890536
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: