IVYRAINE WOMEN'S CLINIC NPI 1962166264

NPI Information

IVYRAINE WOMEN'S CLINIC is a women's health nurse practitioner in Southaven, MS. IVYRAINE WOMEN'S CLINIC NPI is 1962166264. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3964 GOODMAN RD E STE 131
SOUTHAVEN, MS
ZIP 38672-762
Phone: (662) 856-8440

The provider's authorized official is Jennifer Fredrickson .
The authorized official title is Np and has the following contact phone number (662) 856-8440.

The CLIA number assigned to this NPI record is 25D2243740 - practitioner other with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/24/2021 and was last updated on 12/29/2021.

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:

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