Provider Demographics
NPI:1790869014
Name:FORD, ELEANOR SHIELS (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:SHIELS
Last Name:FORD
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-6271
Mailing Address - Country:US
Mailing Address - Phone:601-693-2451
Mailing Address - Fax:601-484-5013
Practice Address - Street 1:5224 VALLEY ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-6271
Practice Address - Country:US
Practice Address - Phone:601-693-2451
Practice Address - Fax:601-484-5013
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR513245363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123997Medicaid
MS00123997Medicaid