Provider Demographics
NPI:1992183800
Name:GERIATRIC CONNECTIONS, LLC
Entity Type:Organization
Organization Name:GERIATRIC CONNECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVELIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:662-574-9492
Mailing Address - Street 1:1483 ST JOHN RD
Mailing Address - Street 2:
Mailing Address - City:BRAXTON
Mailing Address - State:MS
Mailing Address - Zip Code:39044-9419
Mailing Address - Country:US
Mailing Address - Phone:662-574-9492
Mailing Address - Fax:
Practice Address - Street 1:1483 ST JOHN RD
Practice Address - Street 2:
Practice Address - City:BRAXTON
Practice Address - State:MS
Practice Address - Zip Code:39044-9419
Practice Address - Country:US
Practice Address - Phone:662-574-9492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty