Healthcare Provider Details

I. General information

NPI: 1508815713
Provider Name (Legal Business Name): MARCENIA ALDRIDGE CNFP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W RAILROAD AVE
SUMMIT MS
39666-9489
US

IV. Provider business mailing address

PO BOX 490
MCCOMB MS
39649-0490
US

V. Phone/Fax

Practice location:
  • Phone: 601-250-4420
  • Fax: 601-250-4421
Mailing address:
  • Phone: 601-250-4366
  • Fax: 601-250-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR749464
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: