Marla Mathis, FNP
Organization Active NPI Family Nurse Practitioner · Petal, MS
NPI 1285083238 · NPPES record last updated Jun 10, 2016
Key facts
- NPI
- 1285083238
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 852476 (MS)
- Legal business name
- MARLA MATHIS, FNP
- Practice address
- 130 N Main St
Petal, MS 39465-2345 - Phone
- (601) 467-0087
- Fax
- (601) 450-0186
- NPI assigned
- Jun 10, 2016
- Organization subpart
- No
Authorized official
- Name
- Marla Mathis, FNP
- Title
- Owner
- Phone
- (601) 467-0087
Practitioners 1
-
William G. Clark, M.D.
National Provider Directory
Locations
1501 Adeline St
Ste 3
Hattiesburg, MS 39401
Phone (601) 336-8970
1603 Old Amy Rd
Laurel, MS 39440
Phone (601) 428-7100
130 N Main St
Petal, MS 39465
Phone (601) 467-0087
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | 852476 | MS | Yes |
Addresses
Primary practice location
130 N Main St
Petal, MS 39465-2345
Mailing address
300 S 21St Ave
Hattiesburg, MS 39401-7319
Phone (601) 467-0087
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00926271 | Medicaid | MS | |
| 447640YUTG | Other | MS | MEDICARE PTAN INDIVIDUAL |
Other providers in Petal, MS
- Amye B Lovitt
- Rodney N Lovitt
- Stacy L Lowery
- Magnolia Orthodontics of Petal, PLLC
- Magnolia Smiles of Petal PLLC
- Alicia Martin
- Barbara B Mauldin
- Tabatha McKinney
- Tim McWilliams
- Adam Meyers
All providers in Petal, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.