Basic Information
| Provider Information | |||||||||
| NPI: | 1821099482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIVENS-BOLES | ||||||||
| FirstName: | RHONDA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 QUAIL TRL | ||||||||
| Address2: | P O BOX 1216 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 389307315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624552635 | ||||||||
| FaxNumber: | 6624552635 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 MERCER STREET | ||||||||
| Address2: | |||||||||
| City: | TCHULA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628341857 | ||||||||
| FaxNumber: | 6628341859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R864628 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 00125787 | 05 | MS | MEDICAID |