Healthcare Provider Details

I. General information

NPI: 1760397194
Provider Name (Legal Business Name): ELIZABETH FRANKLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11938 HIGHWAY 57
VANCLEAVE MS
39565-8298
US

IV. Provider business mailing address

16504 OLD BILOXI RD
VANCLEAVE MS
39565-7732
US

V. Phone/Fax

Practice location:
  • Phone: 228-282-2804
  • Fax:
Mailing address:
  • Phone: 228-282-2804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4185
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: