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General NPI Number Information
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NPI Number | 1407245715
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI PROFESSIONAL NURSING CARE
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Dates
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Enumeration Date | 01/10/2015
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Last Update Date | 01/10/2015
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Provider Practice Location Address
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Address Line | 879 WILLIAM BLVD APT 11C
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City | RIDGELAND
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State | MS
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Zip | 39157-1510
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Country | US
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Telephone | 769-798-0612
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Fax |
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Provider Business Mailing Address
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Address Line | 879 WILLIAM BLVD APT 11C
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City | RIDGELAND
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State | MS
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Zip | 39157-1510
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Country | US
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Telephone | 769-798-0612
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. LATOYA D LAWSON
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Credential |
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Telephone | 769-798-0612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 1036150
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License Number State | MS
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