Provider Demographics
NPI:1053544155
Name:LIGHTHOUSE HEALTHCARE NANCI W PARISH NP, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE HEALTHCARE NANCI W PARISH NP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCI
Authorized Official - Middle Name:W
Authorized Official - Last Name:PARISH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-798-2005
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-0419
Mailing Address - Country:US
Mailing Address - Phone:601-798-2005
Mailing Address - Fax:877-635-7892
Practice Address - Street 1:6 SIEBENKITTEL CIR
Practice Address - Street 2:SUITE E
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-8777
Practice Address - Country:US
Practice Address - Phone:601-798-2005
Practice Address - Fax:601-798-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR619442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1053544155OtherGROUP NPI
MS00117683Medicaid
01808531OtherGROUP MEDICAID
MS1245348689OtherINDIVIDUAL NPI
MS1245348689OtherINDIVIDUAL NPI