Individual
MR. RALPH LANE BURROUGHS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
8990 LORRAINE RD, GULFPORT, MS 39503-4176
(228) 331-3310
(228) 284-1608
Mailing address
8990 LORRAINE RD, GULFPORT, MS 39503-4176
(228) 331-3310
(228) 214-1608
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R855758
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R855758
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R855758
NURSING LISCENSE
MS
Enumeration date
08/13/2007
Last updated
04/24/2023
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