828 WALK IN CLINIC, Pain Medicine GULFPORT, MS

Contact Information

828 WALK IN CLINIC

12207 HWY 49
SUITE 40
GULFPORT, MS 39503

Phone: 228-832-8872
Fax: 866-809-7246
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Pain Medicine	207LP2900X	05	Physician/Anesthesiology
Nurse Practitioner	363L00000X	50	Nurse Practitioner

Indicates primary specialty

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NPI Profile & details for 828 WALK IN CLINIC · (Female)

NPI Number	`1255608816`
Status	Active
Credentials
Entity	Individual
Enumeration date	11/28/2011
Last updated	11/28/2011 - About 15 years ago
Sole proprietor ¹	Not specified
Identifiers	MS License # 14282 MS License # R791344 MS Medicaid 00114733 MS Medicaid 04078379
Hospital affiliation(s)	Not Available

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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