Organization Name: | COAST NURSE PRACTITIONERS, INC |
NPI Number: | 1962683623 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN M MARTIN (OWNER) |
Mailing Address: | 13300 Rs Kimball Rd Vancleave |
State: | MS US |
Postal Code: | 395657235 |
Phone Number: | 2288264600 |
Fax Number: | 2283928393 |
NPI Enumeration Date: | 11/21/2007 |
NPI Last Update Date: | 11/21/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R851501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |