Healthcare Provider Details

I. General information

NPI: 1770521494
Provider Name (Legal Business Name): RACHEL DUNCAN ROLISON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL DUNCAN KIRKSEY NP

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 UNIVERSITY AVENUE
OXFORD MS
38655
US

IV. Provider business mailing address

2301 S LAMAR BLVD
OXFORD MS
38655
US

V. Phone/Fax

Practice location:
  • Phone: 662-791-9174
  • Fax: 662-377-7626
Mailing address:
  • Phone: 662-513-1175
  • Fax: 662-232-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR856105
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR856105
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR856105
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: