Provider Demographics
NPI:1730285602
Name:CLIFFORD, ROSE ELLEN (APMHNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ELLEN
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:APMHNP
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:ELLEN
Other - Last Name:SKRMETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3407 SHAMROCK CT
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5337
Mailing Address - Country:US
Mailing Address - Phone:601-288-8050
Mailing Address - Fax:
Practice Address - Street 1:3407 SHAMROCK CT
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5337
Practice Address - Country:US
Practice Address - Phone:228-497-0690
Practice Address - Fax:228-497-1363
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR835932363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126966Medicaid
MS00018214Medicaid
MS00018214Medicaid
MS00126966Medicaid