Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 261QS1000X | Clinic/Center | Student Health | | | No |
| 2 | 3140N1450X | Skilled Nursing Facility | Nursing Care, Pediatric | | | No |
| 3 | 251E00000X | Home Health | | | | No |
| 4 | 251B00000X | Case Management | | | | No |
| 5 | 251T00000X | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | | | | No |
| 6 | 261QP0904X | Clinic/Center | Public Health, Federal | | | No |
| 7 | 293D00000X | Physiological Laboratory | | | | No |
| 8 | 251300000X | Local Education Agency (LEA) | | | | No |
| 9 | 291U00000X | Clinical Medical Laboratory | | | | No |
| 10 | 251V00000X | Voluntary or Charitable | | | | No |
| 11 | 347C00000X | Private Vehicle | | | | No |
| 12 | 3336M0002X | Pharmacy | Mail Order Pharmacy | | | No |
| 13 | 333600000X | Pharmacy | | | | No |
| 14 | 305S00000X | Point of Service | | | | No |
| 15 | 163WN1003X | Registered Nurse | Nutrition Support | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 851575 | OTHER | MISSISSIPPI | HEALTHCARE PROVIDER |
| 2 | MS41120 | OTHER | MISSISSIPPI | STATE MEDICAL LICENSE |
