Herrod, Addie Parks

Herrod, Addie Parks is an individual health care provider with primary practice located at 1668 W Peace St , Canton MS 39046-5332. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Herrod, Addie Parks can be contacted via phone (601) 859-5213.

Contact Information

Primary practice address
1668 W Peace St Canton MS 39046-5332
Phone: (601) 859-5213
Fax: (601) 859-8777
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X R715247 Mississippi

Profile Details

NPI number 1689769796
LBN Legal business name Herrod, Addie Parks
Credentials Certified Family Nurse Practitioner (CFNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2006
Last updated May 25th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689769796 NPPES
Mississippi MEDICAID 08184344
Mississippi MEDICAID 05179077

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