Provider Demographics
NPI:1508186024
Name:HEALTHY ME
Entity Type:Organization
Organization Name:HEALTHY ME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LERESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-226-4010
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38902-0186
Mailing Address - Country:US
Mailing Address - Phone:662-226-4010
Mailing Address - Fax:662-226-4495
Practice Address - Street 1:104 DAVIS ST
Practice Address - Street 2:
Practice Address - City:COFFEEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38922-9273
Practice Address - Country:US
Practice Address - Phone:662-614-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute CareGroup - Single Specialty