Healthcare Provider Details

I. General information

NPI: 1063353035
Provider Name (Legal Business Name): SALTY AND LIGHT TRANSPORTATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10217 STEPHENSON LN
OLIVE BRANCH MS
38654-1820
US

IV. Provider business mailing address

10217 STEPHENSON LN
OLIVE BRANCH MS
38654-1820
US

V. Phone/Fax

Practice location:
  • Phone: 901-730-2220
  • Fax:
Mailing address:
  • Phone: 901-730-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: NATHAN MIRANDA
Title or Position: FOUNDER
Credential:
Phone: 901-730-2220