Individual
SHIRLEY C PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5700
(601) 268-5777
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5700
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R634875
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09550526
—
MS
05
—
1049336
—
LA
05
—
812683366A
—
GA
01
—
9724412
AETNA
MS
01
—
P00622808
RAILROAD MEDICARE
MS
01
—
P00815523
RAILROAD MCARE THRU HCCN
MS
01
—
P00974932
RAILROAD MEDICARE
MS
Enumeration date
08/22/2006
Last updated
07/23/2020
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