Healthcare Provider Details

I. General information

NPI: 1174440762
Provider Name (Legal Business Name): KAMRYN ORLIVIYAH RHUBI NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E CANAL ST
PICAYUNE MS
39466-4506
US

IV. Provider business mailing address

448 COUNTY FARM LN NE
BROOKHAVEN MS
39601-9302
US

V. Phone/Fax

Practice location:
  • Phone: 769-926-1137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM11554
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: