Individual
JEANNINE A RACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CGNP
Contact information
Practice address
1530 BROAD AVE, GULFPORT, MS 39501-3601
(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
363LG0600X
Gerontology Nurse Practitioner
Primary
R725927
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02858597
—
MS
01
—
P00342756
RAILROAD MEDICARE
—
Enumeration date
07/14/2006
Last updated
03/10/2011
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