Healthcare Provider Details

I. General information

NPI: 1922374057
Provider Name (Legal Business Name): TONI L LADNER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 MISSION 66 STE B
VICKSBURG MS
39180-3762
US

IV. Provider business mailing address

1600 BROAD AVE
GULFPORT MS
39501-3603
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 855-830-3484
Mailing address:
  • Phone: 228-863-1132
  • Fax: 228-865-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberR850484
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number850484
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: