Provider Demographics
NPI:1407245715
Name:MISSISSIPPI PROFESSIONAL NURSING CARE
Entity Type:Organization
Organization Name:MISSISSIPPI PROFESSIONAL NURSING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-798-0612
Mailing Address - Street 1:879 WILLIAM BLVD
Mailing Address - Street 2:APT 11C
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1510
Mailing Address - Country:US
Mailing Address - Phone:769-798-0612
Mailing Address - Fax:
Practice Address - Street 1:879 WILLIAM BLVD
Practice Address - Street 2:APT 11C
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1510
Practice Address - Country:US
Practice Address - Phone:769-798-0612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1036150253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care