Healthcare Provider Details

I. General information

NPI: 1265869895
Provider Name (Legal Business Name): MARIE SAXON FORD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 22ND AVE STE. A
MERIDIAN MS
39301-4015
US

IV. Provider business mailing address

2104 GAUSE BLVD W STE. A
SLIDELL LA
70460-4130
US

V. Phone/Fax

Practice location:
  • Phone: 601-701-2220
  • Fax: 601-483-9520
Mailing address:
  • Phone: 985-643-4575
  • Fax: 985-643-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR881227
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: