Provider Demographics
NPI:1083098438
Name:TURNER, NELLIE
Entity Type:Individual
Prefix:
First Name:NELLIE
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MOUNT WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39168-4408
Mailing Address - Country:US
Mailing Address - Phone:601-577-0523
Mailing Address - Fax:601-510-9052
Practice Address - Street 1:222 MOUNT WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39168-4408
Practice Address - Country:US
Practice Address - Phone:601-577-0523
Practice Address - Fax:601-510-9052
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14108311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility