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General NPI Number Information
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NPI Number | 1437781010
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Entity Type | Organization
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Legal Business Name | HEARTLAND PEDIATRICS LLC
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 13472 VIDALIA RD
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-8300
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Country | US
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Telephone | 228-344-0039
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Fax |
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Provider Business Mailing Address
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Address Line | 13472 VIDALIA RD
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-8300
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CPNP
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Name | ERIN FAVRE BLANCHETTE
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Credential | APRN, CPNP
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Telephone | 228-344-0039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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