Individual
REBECCA KATHRYN PRIVON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
4 MEDICAL BLVD, HATTIESBURG, MS 39401-7230
(601) 579-5444
(601) 579-3083
Mailing address
3277 E LOUISE DR, STE 350, MERIDIAN, ID 83642-5510
(208) 887-9500
(208) 887-9800
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R895251
MS
363L00000X
Nurse Practitioner
R895251
MS
390200000X
Student in an Organized Health Care Education/Training Program
R895251
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08388778
—
MS
01
—
P01361202
RAILROAD MEDICARE
MS
Enumeration date
05/13/2014
Last updated
08/04/2016
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