Provider Demographics
NPI:1205218690
Name:NURSE PRACTITIONER PROFESSIONALS, PLLC
Entity Type:Organization
Organization Name:NURSE PRACTITIONER PROFESSIONALS, PLLC
Other - Org Name:THERESA RENEE KING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRES. NURSE. PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:601-826-5500
Mailing Address - Street 1:262 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042
Mailing Address - Country:US
Mailing Address - Phone:601-826-5500
Mailing Address - Fax:
Practice Address - Street 1:427 HIGHWAY 51 SE
Practice Address - Street 2:KINGS DAUGHTERS MEDICAL CENTER-WOUND HEALING CENTER
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601
Practice Address - Country:US
Practice Address - Phone:601-835-9444
Practice Address - Fax:601-833-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical