PRIMESOURCE NURSING SERVICES INC NPI 1962573170

NPI Information

NPI: 1962573170
Provider Name: PRIMESOURCE NURSING SERVICES, INC
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Organization

Specialization: Gerontology

Address:
38 PASS RD STE A
GULFPORT, MS
ZIP 39507
Phone: (228) 865-1330
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PRIMESOURCE NURSING SERVICES, INC is a gerontology nurse practitioner in Gulfport, MS. PRIMESOURCE NURSING SERVICES, INC NPI is 1962573170. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

38 PASS RD STE A
GULFPORT, MS
ZIP 39507-107
Phone: (228) 865-1330
Fax: (228) 865-1331

The provider's authorized official is Rhett M Plauche .
The authorized official title is President and has the following contact phone number (228) 865-1330.

The enumeration date for this NPI number is 11/10/2006 and was last updated on 4/2/2018.

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	1041C0700X	Social Worker	Clinical			No
2	363LF0000X	Nurse Practitioner	Family	7381	MISSISSIPPI	No
3	363LG0600X	Nurse Practitioner	Gerontology	7381	MISSISSIPPI	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	06550237	MEDICAID	MISSISSIPPI
2	=========	OTHER	MISSISSIPPI	BCBS OF MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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