Provider Demographics
NPI:1164663936
Name:THRASH, CHRISTIE ANN
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:ANN
Last Name:THRASH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHRISTIE
Other - Middle Name:ANN
Other - Last Name:LADNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:JMM SUITE 2525
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-3921
Mailing Address - Country:US
Mailing Address - Phone:601-815-9528
Mailing Address - Fax:601-984-6439
Practice Address - Street 1:1285 SPRING ST
Practice Address - Street 2:SUITE A
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3423
Practice Address - Country:US
Practice Address - Phone:228-896-6441
Practice Address - Fax:228-896-6576
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR790578208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00055727Medicaid
MS302I509864Medicare PIN
MS302I502907Medicare PIN