Organization
COAST NURSE PRACTITIONERS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M MARTIN NP (OWNER)
(228) 826-4600
Entity
Organization
Contact information
Practice address
13300 RS KIMBALL RD, VANCLEAVE, MS 39565-7235
(228) 826-4600
(228) 392-8393
Mailing address
PO BOX 5386, VANCLEAVE, MS 39565-5386
(228) 826-4600
(228) 392-8393
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R851501
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126136
—
MS
Enumeration date
11/21/2007
Last updated
11/21/2007
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