Provider Demographics
NPI:1053574210
Name:REACH MISSISSIPPI FOUNDATION INC.
Entity type:Organization
Organization Name:REACH MISSISSIPPI FOUNDATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOIRON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:601-661-8400
Mailing Address - Street 1:3420 WISCONSIN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5384
Mailing Address - Country:US
Mailing Address - Phone:601-661-8400
Mailing Address - Fax:601-661-0048
Practice Address - Street 1:3420 WISCONSIN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5384
Practice Address - Country:US
Practice Address - Phone:601-661-8400
Practice Address - Fax:601-661-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR861797174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty