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General NPI Number Information
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NPI Number | 1740920123
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Entity Type | Organization
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Legal Business Name | NPS WITH IVS HYDRATION AND WELLNESS LLC
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Dates
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Enumeration Date | 03/31/2022
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 13034 SHRINERS BLVD # B
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City | BILOXI
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State | MS
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Zip | 39532-8250
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Country | US
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Telephone | 228-333-0133
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Fax | 228-901-5939
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Provider Business Mailing Address
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Address Line | 13066 SHRINERS BLVD STE A
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City | BILOXI
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State | MS
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Zip | 39532-8616
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Country | US
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Telephone | 228-333-0133
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Fax | 228-901-5939
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Authorized Official
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Title or Position | OWNER
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Name | GINA BUTLER
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Credential | NP
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Telephone | 228-697-4567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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