Provider Demographics
NPI:1265869895
Name:FORD, MARIE SAXON (FNP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:SAXON
Last Name:FORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 GAUSE BLVD W
Mailing Address - Street 2:STE. A
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-4130
Mailing Address - Country:US
Mailing Address - Phone:985-643-4575
Mailing Address - Fax:985-643-4513
Practice Address - Street 1:1312 22ND AVE
Practice Address - Street 2:STE. A
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4015
Practice Address - Country:US
Practice Address - Phone:601-701-2220
Practice Address - Fax:601-483-9520
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR881227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03221576Medicaid
MS03221576Medicaid