Provider Demographics
NPI:1245462282
Name:CAIN, RALPH T (FNP)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:T
Last Name:CAIN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SUNSET DR
Mailing Address - Street 2:STE Q
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4086
Mailing Address - Country:US
Mailing Address - Phone:662-294-9101
Mailing Address - Fax:662-294-9104
Practice Address - Street 1:1300 SUNSET DR
Practice Address - Street 2:STE Q
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4086
Practice Address - Country:US
Practice Address - Phone:662-294-9101
Practice Address - Fax:662-294-9104
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR825333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245462282OtherNPI