1316417249 NPI number — NAR'CISSA PATTON NP

Table of content: NAR'CISSA PATTON NP (NPI 1316417249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316417249 NPI number — NAR'CISSA PATTON NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATTON
Provider First Name:
NAR'CISSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCDONALD
Provider Other First Name:
NAR'CISSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316417249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7629
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIBERVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39540-7601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-218-9588
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 BEAUVOIR RD STE B2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39531-4008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-283-8999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  902915 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 902915 . This is a "MISSISSIPPI BOARD OF NURSING" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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