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General NPI Number Information
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NPI Number | 1114583994
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Entity Type | Organization
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Legal Business Name | PRIMESOURCE NURSING SERVICES, INC
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 2279 ATKINSON RD
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City | BILOXI
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State | MS
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Zip | 39531-2209
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Country | US
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Telephone | 228-865-1330
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Fax | 228-865-1331
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Provider Business Mailing Address
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Address Line | PO BOX 6705
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City | GULFPORT
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State | MS
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Zip | 39506-6705
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Country | US
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Telephone | 228-865-1330
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Fax | 228-865-1331
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Authorized Official
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Title or Position | PRESIDENT
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Name | RHETT PLAUCHE
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Credential |
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Telephone | 228-865-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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