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General NPI Number Information
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NPI Number | 1245815844
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Entity Type | Organization
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Legal Business Name | NULIFE HEALTHCARE, LLC
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 120 HOLT COLLIER DR STE C
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City | VICKSBURG
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State | MS
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Zip | 39183-4408
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Country | US
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Telephone | 601-738-5565
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Fax | 601-738-5544
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Provider Business Mailing Address
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Address Line | 120 HOLT COLLIER DR STE C
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City | VICKSBURG
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State | MS
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Zip | 39183-4408
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Country | US
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Telephone | 601-738-5565
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Fax | 601-738-5544
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | STACY BRIGGS
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Credential | PMHNP BC
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Telephone | 601-738-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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