Provider Demographics
NPI:1063026086
Name:MARTIN, RACHEL ROMERO (FNP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ROMERO
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:ELIZABETH
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:141 DARBY WAY
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-1915
Mailing Address - Country:US
Mailing Address - Phone:662-769-3804
Mailing Address - Fax:
Practice Address - Street 1:1207 HIGHWAY 182 W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9013
Practice Address - Country:US
Practice Address - Phone:662-320-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily