Basic Information
| Provider Information | |||||||||
| NPI: | 1205218690 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NURSE PRACTITIONER PROFESSIONALS, PLLC | ||||||||
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| OtherOrganizationName: | THERESA RENEE KING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 262 CORNERSTONE DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018265500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 427 HIGHWAY 51 SE | ||||||||
| Address2: | KINGS DAUGHTERS MEDICAL CENTER-WOUND HEALING CENTER | ||||||||
| City: | BROOKHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018359444 | ||||||||
| FaxNumber: | 6018335210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2015 | ||||||||
| LastUpdateDate: | 06/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | THERESA | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRES. NURSE. PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 6018265500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CFNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.