Healthcare Provider Details

I. General information

NPI: 1902068745
Provider Name (Legal Business Name): RACHEL NICOLE HULL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 HIGHWAY 39 N
MERIDIAN MS
39301-1007
US

IV. Provider business mailing address

1314 19TH AVE
MERIDIAN MS
39301-4116
US

V. Phone/Fax

Practice location:
  • Phone: 601-484-6180
  • Fax: 601-482-0944
Mailing address:
  • Phone: 601-703-4282
  • Fax: 601-703-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21690
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: