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General NPI Number Information
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NPI Number | 1336735323
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Entity Type | Organization
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Legal Business Name | THE PRUDENT NURSE
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 35 VILLAGE GREEN CIR
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City | JACKSON
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State | MS
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Zip | 39211-2931
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Country | US
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Telephone | 601-573-7833
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Fax |
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Provider Business Mailing Address
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Address Line | 35 VILLAGE GREEN CIR
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City | JACKSON
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State | MS
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Zip | 39211-2931
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Country | US
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Telephone | 601-573-7833
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | CRYSTAL TUCKER
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Credential | RN
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Telephone | 601-573-7833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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