Provider Demographics
NPI:1508547472
Name:COAST PEDIATRICS
Entity Type:Organization
Organization Name:COAST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:PAETZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP-PC
Authorized Official - Phone:228-273-0400
Mailing Address - Street 1:7312 PARK RIDGE DR S
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-6164
Mailing Address - Country:US
Mailing Address - Phone:228-273-0400
Mailing Address - Fax:228-333-0759
Practice Address - Street 1:5605 HIGHWAY 614 # B
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562-7569
Practice Address - Country:US
Practice Address - Phone:228-273-0400
Practice Address - Fax:228-333-0759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty