MEDICARE: SANDREAL A POUNDS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	337543	MS
2	164W00000X	Licensed Practical Nurse	2-073401	AL

General Provider Information

NPI Number	:	1215539689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDREAL A POUNDS LPN

Provider Business Mailing Address
First Line	:	PO BOX 763
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39403-0763
Country	:	US
Telephone Number	:	601-653-7536
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 THORNHILL DR STE A
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-1559
Country	:	US
Telephone Number	:	601-653-7536
Fax Number	:	769-500-1661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	11/11/2020

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