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General NPI Number Information
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NPI Number | 1639594930
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Entity Type | Organization
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Legal Business Name | US STAR NURSING
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Dates
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Enumeration Date | 02/23/2014
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Last Update Date | 02/23/2014
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Provider Practice Location Address
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Address Line | 7 PRIMROSE LN
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City | NATCHEZ
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State | MS
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Zip | 39120-4877
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Country | US
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Telephone | 601-304-2043
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Fax |
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Provider Business Mailing Address
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Address Line | 7 PRIMROSE LN 48 EAST WOODLAWN STREET
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City | NATCHEZ
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State | MS
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Zip | 39120-4877
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Country | US
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Telephone | 601-304-2043
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MS. TARSHA CARTER AMBEAU
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Credential |
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Telephone | 601-304-2043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | R863813
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License Number State | MS
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