St Michaels Urgent Care Of Hattiesburg
Nurse Practitioner, Family in Hattiesburg, MS. Organization (NPI-2).
NPI number1124459136
StatusActive
Last updated in NPPESSep 6, 2016
Details
- NPI
- 1124459136
- Entity type
- Organization (NPI-2)
- Legal business name
- St Michaels Urgent Care Of Hattiesburg
- Organization subpart
- Yes
- Enumeration date
- Dec 2, 2013
- Last updated
- Sep 6, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | R875464 | MS | Yes |
| 174400000X | Specialist | – | – |
Practice location
3700 Hardy StHattiesburg, MS 39402-1610
Phone 601-602-2014 · Fax 601-602-2015
Mailing address
3700 Hardy StHattiesburg, MS 39402-1610
Phone 601-602-2014 · Fax 601-602-2015
Authorized official
Marva Joyce Cooley
Credentialling Director
6019092539
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