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General NPI Number Information
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NPI Number | 1265630834
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Entity Type | Organization
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Legal Business Name | NEW BEGINNINGS
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 79 PINK SMITH RD
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City | CARRIERE
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State | MS
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Zip | 39426-8641
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Country | US
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Telephone | 601-749-3887
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Fax |
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Provider Business Mailing Address
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Address Line | 79 PINK SMITH RD
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City | CARRIERE
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State | MS
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Zip | 39426-8641
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Country | US
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Telephone | 601-749-3887
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | CAROLYN BLYTHE A. BLYTHE
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Credential | PHMNP
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Telephone | 601-749-3887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R606391
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License Number State | MS
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