Provider Demographics
NPI:1487026647
Name:VINCENT, ROXANNE (PCA)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 HWY 11 S
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466
Mailing Address - Country:US
Mailing Address - Phone:601-953-3305
Mailing Address - Fax:
Practice Address - Street 1:1753 HIGHWAY 11 S
Practice Address - Street 2:15 SAM MITCHELL RD
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-8056
Practice Address - Country:US
Practice Address - Phone:601-953-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant