Healthcare Provider Details

I. General information

NPI: 1619155140
Provider Name (Legal Business Name): ESTHER W. QUINN MS,RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 MAPP TURNER RD
OAK VALE MS
39656-7042
US

IV. Provider business mailing address

PO BOX 885
PRENTISS MS
39474-0885
US

V. Phone/Fax

Practice location:
  • Phone: 601-792-9175
  • Fax:
Mailing address:
  • Phone: 601-792-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDO365
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: