Healthcare Provider Details

I. General information

NPI: 1194830398
Provider Name (Legal Business Name): RUBY L LUCROY CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 HIGHWAY 13 S
MORTON MS
39117-3353
US

IV. Provider business mailing address

PO BOX 2065
MERIDIAN MS
39302-2065
US

V. Phone/Fax

Practice location:
  • Phone: 601-732-8612
  • Fax: 601-732-1957
Mailing address:
  • Phone: 601-703-4282
  • Fax: 601-703-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR543225
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: