Provider Demographics
NPI:1457934226
Name:ALFRED, SEDRA E
Entity Type:Individual
Prefix:
First Name:SEDRA
Middle Name:E
Last Name:ALFRED
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 1:12 TEN MILE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-7052
Mailing Address - Country:US
Mailing Address - Phone:601-522-5780
Mailing Address - Fax:
Practice Address - Street 1:12 TEN MILE CREEK RD
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-7052
Practice Address - Country:US
Practice Address - Phone:601-522-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1277650376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker