Individual
GRACE P FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
302 HIGHWAY 11 S, POPLARVILLE, MS 39470-2625
(601) 403-8283
(601) 403-8283
Mailing address
305 W MOODY ST, POPLARVILLE, MS 39470-7338
(601) 795-4543
(601) 795-4238
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
875721
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07509343
—
MS
01
—
12346339
CAQH
MS
01
—
9858831
AETNA
MS
Enumeration date
02/08/2012
Last updated
11/25/2020
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