Healthcare Provider Details

I. General information

NPI: 1992800916
Provider Name (Legal Business Name): RUTH SHIRLEY SESERA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 OLD MOBILE HIGHWAY
PASCAGOULA MS
39581
US

IV. Provider business mailing address

10052 PLANTATION DR
DAPHNE AL
36526-8574
US

V. Phone/Fax

Practice location:
  • Phone: 228-762-4642
  • Fax: 228-207-3087
Mailing address:
  • Phone: 251-621-8485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-090086
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR879202
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: