Provider Demographics
NPI:1114539244
Name:SLEDGE, MARQUITA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:
Last Name:SLEDGE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-0194
Mailing Address - Country:US
Mailing Address - Phone:626-126-0896
Mailing Address - Fax:662-612-6313
Practice Address - Street 1:565 N ROBINSON ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2118
Practice Address - Country:US
Practice Address - Phone:662-612-6089
Practice Address - Fax:662-612-6313
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904524363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health