Organization
V A NORTH
Active
Other names
V A NORTH
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRENCE D NICKENS PT (OWNER)
(601) 636-6019
Entity
Organization
Contact information
Practice address
500 W COUNTY LINE RD, TOUGALOO, MS 39174-9700
(601) 636-6019
(601) 661-8457
Mailing address
PO BOX 3183, RIDGELAND, MS 39158-3183
(601) 636-6019
(601) 661-8457
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT3573
MS
225X00000X
Occupational Therapist
Primary
OT2019
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02900724
—
MS
Enumeration date
12/14/2006
Last updated
09/11/2025
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