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General NPI Number Information
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NPI Number | 1508547472
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Entity Type | Organization
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Legal Business Name | COAST PEDIATRICS
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 5605 HIGHWAY 614 # B
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City | MOSS POINT
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State | MS
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Zip | 39562-7569
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Country | US
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Telephone | 228-273-0400
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Fax | 228-333-0759
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Provider Business Mailing Address
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Address Line | 7312 PARK RIDGE DR S
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City | MOSS POINT
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State | MS
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Zip | 39562-6164
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Country | US
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Telephone | 228-273-0400
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Fax | 228-333-0759
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. MARGARET FAYE PAETZ
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Credential | CPNP-PC
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Telephone | 228-273-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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