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NPI Code Detail

MEDICARE: RUTH C GADDIS FNP

MEDICARE: RUTH C GADDIS FNP
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
1363LF0000XFamily Nurse PractitionerR717142MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831130715
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUTH C GADDIS FNP
Provider Business Mailing Address
First Line : PO BOX 520
Second Line :
City : MARION
State : MS
Zip : 39342-0520
Country : US
Telephone Number : 601-646-7700
Fax Number : 888-735-7202
Provider Business Practice Location Address
First Line : 330 N BROAD ST
Second Line :
City : FOREST
State : MS
Zip : 39074-3508
Country : US
Telephone Number : 601-469-4771
Fax Number : 601-469-4724
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 11/18/2010

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