Provider Demographics
NPI:1003463928
Name:NP PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:NP PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:662-347-1953
Mailing Address - Street 1:17 CHURCH CV
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:MS
Mailing Address - Zip Code:38726-9430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 CHURCH CV
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:MS
Practice Address - Zip Code:38726-9430
Practice Address - Country:US
Practice Address - Phone:662-347-1953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03924389Medicaid