Provider Demographics
NPI:1295249373
Name:LETT, SADIE MYERS (NUREE)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:MYERS
Last Name:LETT
Suffix:
Gender:F
Credentials:NUREE
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 434
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-0434
Mailing Address - Country:US
Mailing Address - Phone:601-291-4560
Mailing Address - Fax:
Practice Address - Street 1:1931 LINCOLNSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1217
Practice Address - Country:US
Practice Address - Phone:601-957-2342
Practice Address - Fax:601-957-2342
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR740012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR740012OtherNURSING