Provider Demographics
NPI:1669457925
Name:FERO, JOSEPH P (NP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:FERO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12313 HIGHWAY 57
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-9501
Mailing Address - Country:US
Mailing Address - Phone:228-826-1990
Mailing Address - Fax:228-826-1998
Practice Address - Street 1:12313 HIGHWAY 57
Practice Address - Street 2:
Practice Address - City:VANCLEAVE
Practice Address - State:MS
Practice Address - Zip Code:39565-9501
Practice Address - Country:US
Practice Address - Phone:228-826-1990
Practice Address - Fax:228-826-1998
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR588067363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02128275Medicaid
84-1670761OtherTAX ID #
84-1670761OtherTAX ID #
P37606Medicare UPIN