Provider Demographics
NPI:1558559823
Name:BOOKERT, RITHA G (NP)
Entity Type:Individual
Prefix:
First Name:RITHA
Middle Name:G
Last Name:BOOKERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:RITHA
Other - Middle Name:G
Other - Last Name:BOOKERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:100 VINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-9113
Mailing Address - Country:US
Mailing Address - Phone:601-829-3940
Mailing Address - Fax:601-829-3941
Practice Address - Street 1:100 VINE DRIVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-9113
Practice Address - Country:US
Practice Address - Phone:601-829-3940
Practice Address - Fax:601-829-3941
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01786739Medicaid