Provider Demographics
NPI:1508995499
Name:RICE, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RICE
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 1:120 BURKE CALHOUN CITY RD
Mailing Address - Street 2:PO BOX 1210
Mailing Address - City:CALHOUN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38916-9690
Mailing Address - Country:US
Mailing Address - Phone:662-628-5116
Mailing Address - Fax:662-628-5117
Practice Address - Street 1:120 BURKE CALHOUN CITY RD
Practice Address - Street 2:
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916
Practice Address - Country:US
Practice Address - Phone:662-628-5116
Practice Address - Fax:662-628-5117
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508995499OtherNPI NUMBER
MS02072547Medicaid