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General NPI Number Information
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NPI Number | 1366837767
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Entity Type | Organization
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Legal Business Name | ADVANCE HEALTHCARE SOLUTIONS
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 600 E RAILROAD ST
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City | LONG BEACH
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State | MS
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Zip | 39560-4918
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Country | US
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Telephone | 228-297-5597
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37
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City | LONG BEACH
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State | MS
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Zip | 39560-0037
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Country | US
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Telephone | 228-297-5597
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TRENITA L MOORE
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Credential | FNP-BC
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Telephone | 228-297-5597
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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