Individual
TRACI DAVIS SUBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
421 S 28TH AVE STE 200, HATTIESBURG, MS 39401-7208
(601) 268-5640
(601) 579-5240
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5640
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
814179
MS
363LW0102X
Women's Health Nurse Practitioner
Primary
R814179
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118984
—
MS
01
—
12181303
CAQH ID #
MS
01
—
2285175
UNITED HEALTHCARE
MS
01
—
7059463
AETNA
MS
Enumeration date
04/18/2007
Last updated
08/11/2020
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