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General NPI Number Information
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NPI Number | 1780144451
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Entity Type | Individual
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Provider Name | VIBHA MISHRA-NICAUD DO
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Gender | Female
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 1340 BROAD AVE STE 330
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City | GULFPORT
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State | MS
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Zip | 39501-2464
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Country | US
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Telephone | 228-575-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 503 E SCENIC DR
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-4510
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Country | US
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Telephone | 228-596-6306
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 35299
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License Number State | MS
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