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General NPI Number Information
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NPI Number | 1861920407
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Entity Type | Organization
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Legal Business Name | MICAH A LADNER FNP-C LLC
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 05/26/2017
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Provider Practice Location Address
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Address Line | 22549 FENTON DEDEAUX RD
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City | KILN
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State | MS
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Zip | 39556-6576
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Country | US
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Telephone | 228-493-3404
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Fax | 228-493-3404
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Provider Business Mailing Address
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Address Line | PO BOX 6571
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City | DIAMONDHEAD
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State | MS
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Zip | 39525-6501
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Country | US
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Telephone | 228-493-3404
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICAH ANTHONY LADNER
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Credential | FNP
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Telephone | 228-493-3404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 901609
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License Number State | MS
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