Rebecca Fletcher, LPN

Individual provider Active NPI Licensed Practical Nurse · Gulfport, MS

NPI 1629532007 · NPPES record last updated Jul 12, 2019

Key facts

NPI
1629532007
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
2040043 (AL)
Practice address
1600 Broad Ave
Gulfport, MS 39501-3603
Phone
(228) 865-1719
Fax
(228) 865-1780
NPI assigned
Jan 30, 2019
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
2040043ALMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 2040043 AL Yes

Addresses

Primary practice location

1600 Broad Ave
Gulfport, MS 39501-3603

Mailing address

1600 Broad Ave
Gulfport, MS 39501-3603
Phone (228) 865-1719

Other providers in Gulfport, MS

All providers in Gulfport, MS · Licensed Practical Nurse in Mississippi

Sources for this page

Verify at the official NPI Registry.