Organization
PRIMESOURCE NURSING SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANA LEIGH PLAUCHE (PRESIDENT)
(228) 865-1330
Entity
Organization
Contact information
Practice address
4906 KENDALL AVE, GULFPORT, MS 39507-4409
(228) 865-1330
(228) 865-1331
Mailing address
PO BOX 6705, GULFPORT, MS 39506-6705
(228) 865-1330
(228) 865-1331
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06550237
—
MS
Enumeration date
09/27/2006
Last updated
08/22/2020
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