Healthcare Provider Details

I. General information

NPI: 1225547185
Provider Name (Legal Business Name): SHEREDA J SAINT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEREDA J JUSTICE

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 CITY AVE N
RIPLEY MS
38663-1102
US

IV. Provider business mailing address

13 2ND ST
RIENZI MS
38865-9500
US

V. Phone/Fax

Practice location:
  • Phone: 662-993-9336
  • Fax: 662-993-9338
Mailing address:
  • Phone: 662-415-3459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902333
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: