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General NPI Number Information
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NPI Number | 1013161132
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Entity Type | Organization
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Legal Business Name | WESTMORELAND DERMATOLOGY AND SURGERY CENTER
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 11/17/2008
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Provider Practice Location Address
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Address Line | 2110 5TH ST N
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City | COLUMBUS
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State | MS
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Zip | 39705-2210
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Country | US
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Telephone | 662-243-2435
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Fax | 662-328-7037
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Provider Business Mailing Address
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Address Line | 2110 5TH ST N PO BOX 8695
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City | COLUMBUS
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State | MS
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Zip | 39705-2210
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Country | US
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Telephone | 662-243-2435
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Fax | 662-328-7037
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KAREN VICKERS
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Credential |
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Telephone | 662-243-2435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R798833
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License Number State | MS
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