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General NPI Number Information
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NPI Number | 1376815134
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Entity Type | Individual
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Provider Name | GRACE P FORD FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 302 HIGHWAY 11 S
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City | POPLARVILLE
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State | MS
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Zip | 39470-2625
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Country | US
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Telephone | 601-403-8283
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Fax | 601-403-8283
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Provider Business Mailing Address
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Address Line | 305 W MOODY ST
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City | POPLARVILLE
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State | MS
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Zip | 39470-7338
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Country | US
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Telephone | 601-795-4543
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Fax | 601-795-4238
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 875721
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License Number State | MS
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