| Doctor Name: | MR. VANCE RAY WARDEN |
| NPI Number: | 1801928700 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.C. |
| License Number: | F0113056 |
| Business Practice Address: | 19621 Hwy 63 Moss Point, MS - 39562 |
| Business Phone Number: | 2285880188 |
| Business Fax Number: | 2285889184 |
| Mailing Address: | Po Box 901, HURLEY |
| State: | MS |
| Postal Code: | 395550901 |
| Phone Number: | 2285880188 |
| Fax Number: | 2285889184 |
| NPI Enumeration Date: | 03/09/2007 |
| NPI Last Update Date: | 07/31/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F0113056 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |