Mack, Vickie Rochelle

Mack, Vickie Rochelle is an sole proprietor health care provider with primary practice located at 811 Alvaredo St , Jackson MS 39204-5317. She recently has only one registered license in Nursing Service Providers / Licensed Practical Nurse, which is considered as her primary health care specialty. Mack, Vickie Rochelle can be contacted via phone (601) 372-8941.

Contact Information

Primary practice address
811 Alvaredo St Jackson MS 39204-5317
Phone: (601) 372-8941
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Licensed Practical Nurse 164W00000X P122165 Mississippi

Profile Details

NPI number 1912088055
LBN Legal business name Mack, Vickie Rochelle
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 17th, 2006
Last updated Jul 9th, 2007 - about 19 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 1912088055 NPPES
Mississippi MEDICAID 00770172

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