Healthcare Provider Details

I. General information

NPI: 1750993481
Provider Name (Legal Business Name): NIVA JAMICE KING ALEXANDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NIVA JAMICE KING RN

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 10/24/2020
Certification Date: 10/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 S PEAR ORCHARD ROAD SUITE 106 #553
RIDGELAND MS
39157-4859
US

IV. Provider business mailing address

PO BOX 974
DECATUR MS
39327-0974
US

V. Phone/Fax

Practice location:
  • Phone: 769-218-8891
  • Fax: 855-918-4758
Mailing address:
  • Phone: 205-393-2327
  • Fax: 855-918-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number898121
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number1-109693
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: