Provider Demographics
NPI:1558386920
Name:COLE, RONJA (NP)
Entity Type:Individual
Prefix:
First Name:RONJA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N 1ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-2718
Mailing Address - Country:US
Mailing Address - Phone:662-340-1138
Mailing Address - Fax:662-728-5185
Practice Address - Street 1:202 N 1ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-2718
Practice Address - Country:US
Practice Address - Phone:662-340-1138
Practice Address - Fax:662-728-5185
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR850478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02852251Medicaid
MS302I503061OtherMEDICARE PTAN