Healthcare Provider Details

I. General information

NPI: 1083726491
Provider Name (Legal Business Name): BECKY JAN MERCIER RN, CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 E BROAD ST
MONTICELLO MS
39654-7703
US

IV. Provider business mailing address

31 JUBILEE PT
HATTIESBURG MS
39402-7620
US

V. Phone/Fax

Practice location:
  • Phone: 601-587-4051
  • Fax: 601-587-1256
Mailing address:
  • Phone: 601-271-9078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR862123
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: