Provider Demographics
NPI:1295370088
Name:PACE, NATALIE KATHLEEN (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:KATHLEEN
Last Name:PACE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:NATALIE
Other - Middle Name:PACE
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN RN, FNP-C
Mailing Address - Street 1:204 WINDROSE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8005
Mailing Address - Country:US
Mailing Address - Phone:601-832-5246
Mailing Address - Fax:
Practice Address - Street 1:971 LAKELAND DR STE 557
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4661
Practice Address - Country:US
Practice Address - Phone:601-200-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907426163W00000X
MS904978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty