Provider Demographics
NPI:1225671456
Name:LEDFORD, JOSHUA (NP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 TRACE COLONY PARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8851
Mailing Address - Country:US
Mailing Address - Phone:601-944-5585
Mailing Address - Fax:601-366-8507
Practice Address - Street 1:230 TRACE COLONY PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8851
Practice Address - Country:US
Practice Address - Phone:601-944-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903563363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health