Healthcare Provider Details

I. General information

NPI: 1427489756
Provider Name (Legal Business Name): HEATHER RHODEN, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3631 BIENVILLE BLVD SUITE A
OCEAN SPRINGS MS
39564-5702
US

IV. Provider business mailing address

3631 BIENVILLE BLVD SUITE A
OCEAN SPRINGS MS
39564-5702
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-0585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20179
License Number StateMS

VIII. Authorized Official

Name: DR. HEATHER RHODEN
Title or Position: OWNER
Credential:
Phone: 228-818-0585