Provider Demographics
NPI:1740500214
Name:LITTERER, RACHEL ELLEN (FNP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELLEN
Last Name:LITTERER
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 1:11273 HIGHWAY 61 N
Mailing Address - Street 2:
Mailing Address - City:ROBINSONVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38664-9705
Mailing Address - Country:US
Mailing Address - Phone:662-363-3224
Mailing Address - Fax:662-363-3234
Practice Address - Street 1:3040 GOODMAN RD W
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1189
Practice Address - Country:US
Practice Address - Phone:662-230-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR876287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1740500214Medicare PIN