Provider Demographics
NPI:1780722280
Name:ROLAND, LINDA N (NP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:N
Last Name:ROLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-6110
Mailing Address - Country:US
Mailing Address - Phone:601-267-5027
Mailing Address - Fax:
Practice Address - Street 1:204 CHIPLEY ST.
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051
Practice Address - Country:US
Practice Address - Phone:601-267-3072
Practice Address - Fax:601-267-6277
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR505307363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124030Medicaid
MSQ06099Medicare UPIN