Healthcare Provider Details

I. General information

NPI: 1255004073
Provider Name (Legal Business Name): LAURA ASHLEY RHEA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 BARNES CROSSING RD
TUPELO MS
38804-0909
US

IV. Provider business mailing address

159 GUM TREE RUN
TUPELO MS
38801-8649
US

V. Phone/Fax

Practice location:
  • Phone: 662-841-0002
  • Fax:
Mailing address:
  • Phone: 662-871-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRHEA-Z6PR51
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: