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General NPI Number Information
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NPI Number | 1407114432
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Entity Type | Organization
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Legal Business Name | EMMANUEL HEALTH SERVICES
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 637 HIGHWAY 51 NORTH SUITE E
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City | RIDGELAND
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State | MS
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Zip | 39157
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Country | US
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Telephone | 601-209-5133
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2056
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City | RIDGELAND
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State | MS
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Zip | 39158-2056
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Country | US
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Telephone | 601-605-8820
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Fax | 601-605-8920
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Authorized Official
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Title or Position | CEO
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Name | MS. DONNA KAY PITTMAN
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Credential | FNP
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Telephone | 601-209-5133
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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 | R845316
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License Number State | MS
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