Provider Demographics
NPI:1215539689
Name:POUNDS, SANDREAL A (LPN)
Entity Type:Individual
Prefix:
First Name:SANDREAL
Middle Name:A
Last Name:POUNDS
Suffix:
Gender:F
Credentials:LPN
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 763
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-0763
Mailing Address - Country:US
Mailing Address - Phone:601-653-7536
Mailing Address - Fax:
Practice Address - Street 1:115 THORNHILL DR STE A
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1559
Practice Address - Country:US
Practice Address - Phone:601-653-7536
Practice Address - Fax:769-500-1661
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS337543164W00000X
AL2-073401164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse