Individual
MISS RACHEL LORRAINE STATEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
112 GRAND OLE OAKS DR, APT # 2, BELDEN, MS 38826-7014
(662) 269-2105
Mailing address
112 GRAND OLE OAKS DR, APT # 2, BELDEN, MS 38826-7014
(662) 269-2105
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R883957
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08855320
—
MS
Enumeration date
01/29/2010
Last updated
03/22/2012
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