Doctor Name: | MRS. LESLIE ESTES SHAVERS |
NPI Number: | 1003111543 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | R872675 |
Business Practice Address: | 2210 Denny Ave Pascagoula, MS - 395673416 |
Business Phone Number: | 2283726043 |
Business Fax Number: | |
Mailing Address: | 12508 Highland Dr, GULFPORT |
State: | MS |
Postal Code: | 395037621 |
Phone Number: | 2288617744 |
Fax Number: | |
NPI Enumeration Date: | 01/13/2011 |
NPI Last Update Date: | 06/27/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R872675 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |