Provider Demographics
NPI:1013689199
Name:GORDON CROWELL, NEKESHA JOHNNYETTE
Entity Type:Individual
Prefix:
First Name:NEKESHA
Middle Name:JOHNNYETTE
Last Name:GORDON CROWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7230
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39304-7230
Mailing Address - Country:US
Mailing Address - Phone:601-934-0071
Mailing Address - Fax:
Practice Address - Street 1:5205 BROOKINS RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-9581
Practice Address - Country:US
Practice Address - Phone:601-934-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251E00000XAgenciesHome Health