Healthcare Provider Details

I. General information

NPI: 1669457925
Provider Name (Legal Business Name): JOSEPH P FERO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12313 HIGHWAY 57
VANCLEAVE MS
39565-9501
US

IV. Provider business mailing address

12313 HIGHWAY 57
VANCLEAVE MS
39565-9501
US

V. Phone/Fax

Practice location:
  • Phone: 228-826-1990
  • Fax: 228-826-1998
Mailing address:
  • Phone: 228-826-1990
  • Fax: 228-826-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR588067
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: