Provider Demographics
NPI:1487200325
Name:WARD, NITA GEAN
Entity Type:Individual
Prefix:
First Name:NITA
Middle Name:GEAN
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3184 BARLAND RD
Mailing Address - Street 2:
Mailing Address - City:PATTISON
Mailing Address - State:MS
Mailing Address - Zip Code:39144-9439
Mailing Address - Country:US
Mailing Address - Phone:601-642-4612
Mailing Address - Fax:
Practice Address - Street 1:3184 BARLAND RD
Practice Address - Street 2:
Practice Address - City:PATTISON
Practice Address - State:MS
Practice Address - Zip Code:39144-9439
Practice Address - Country:US
Practice Address - Phone:601-642-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider