Basic Information
Provider Information
NPI: 1821745233
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAEF
FirstName: RACHAEL
MiddleName: COURTNEY
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 HIGHWAY 90
Address2:  
City: GAUTIER
State: MS
PostalCode: 395535340
CountryCode: US
TelephoneNumber: 2284977576
FaxNumber: 2284978869
Practice Location
Address1: 3099 BIENVILLE BLVD
Address2:  
City: OCEAN SPRINGS
State: MS
PostalCode: 395644308
CountryCode: US
TelephoneNumber: 2288722403
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/05/2022
LastUpdateDate: 03/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X905162MSY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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