Organization
SUPERIOR SOLES
Active
Other names
Superior Soles
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LARONA RACHELLE SEARCY FNP (FNP)
(601) 503-0335
Entity
Organization
Contact information
Practice address
1888 MAIN ST, MADISON, MS 39110
(601) 503-0335
Mailing address
161 WOODLAND DR, MADISON, MS 39110-8751
(601) 503-0335
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/10/2020
Last updated
01/10/2020
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