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General NPI Number Information
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NPI Number | 1487026647
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Entity Type | Individual
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Provider Name | ROXANNE VINCENT P.C.A
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Gender | Female
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 1753 HIGHWAY 11 S 15 SAM MITCHELL RD
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City | PICAYUNE
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State | MS
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Zip | 39466-8056
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Country | US
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Telephone | 601-953-3305
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Fax |
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Provider Business Mailing Address
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Address Line | 1753 HWY 11 S
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City | PICAYUNE
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State | MS
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Zip | 39466
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Country | US
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Telephone | 601-953-3305
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Fax |
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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