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General NPI Number Information
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NPI Number | 1053544155
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE HEALTHCARE NANCI W PARISH NP, LLC
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 6 SIEBENKITTEL CIR SUITE E
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City | CARRIERE
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State | MS
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Zip | 39426-8777
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Country | US
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Telephone | 601-798-2005
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Fax | 601-798-2052
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Provider Business Mailing Address
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Address Line | PO BOX 419
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City | PICAYUNE
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State | MS
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Zip | 39466-0419
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Country | US
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Telephone | 601-798-2005
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Fax | 877-635-7892
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Authorized Official
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Title or Position | OWNER
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Name | NANCI W PARISH
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Credential | NP
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Telephone | 601-798-2005
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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 | R619442
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License Number State | MS
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