Individual
CHARLIE ADDERLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN126097
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08977750
—
MS
01
—
P01679805
RAILROAD MEDICARE
MS
Enumeration date
02/22/2016
Last updated
01/20/2023
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