Individual
RONALD PRICE TYNES JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5800
(601) 261-3530
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 425-5544
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R871257
MS
363LA2100X
Acute Care Nurse Practitioner
Primary
871257
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08439781
—
MS
01
—
3593185
UNITED HEALTHCARE
MS
01
—
8609841
CIGNA
MS
01
—
972790
WINDSOR
MS
01
—
9811941
AETNA
MS
01
—
P01206666
RAILROAD MEDICARE
MS
Enumeration date
03/12/2013
Last updated
06/18/2020
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