Individual
ANNE P BERTHOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
1227 N STATE ST, STE 101, JACKSON, MS 39202-2002
(601) 355-2485
(601) 353-1463
Mailing address
1227 N STATE ST, STE 101, JACKSON, MS 39202-2002
(601) 355-2485
(601) 353-1463
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R845073
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121962
—
MS
05
—
1432652
—
LA
Enumeration date
06/10/2005
Last updated
12/02/2009
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