Basic Information
| Provider Information | |||||||||
| NPI: | 1366756678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUISSON | ||||||||
| FirstName: | PATRICE | ||||||||
| MiddleName: | MURRAY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 RIVER OAKS DR STE 304 | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019361170 | ||||||||
| FaxNumber: | 6019361331 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 RIVER OAKS DR STE 304 | ||||||||
| Address2: | |||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019361170 | ||||||||
| FaxNumber: | 6019361331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2010 | ||||||||
| LastUpdateDate: | 08/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1005X | D1045 | MS | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal |
No ID Information.