=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437882800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUCARE MEDICAL AND WEIGHT LOSS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2022
-----------------------------------------------------
Last Update Date | 02/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 249 BEAUVOIR RD STE C1-3
-----------------------------------------------------
City | BILOXI
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39531-4008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-283-8999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7629
-----------------------------------------------------
City | DIBERVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39540-7601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-283-8999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | NAR'CISSA MCDONALD
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 228-218-9588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------