| Primesource Nursing Services, Inc | |
|
1500 Broad Ave Gulfport MS 39501-3601 | |
| (228) 865-1330 | |
| (228) 865-1331 |
| Full Name | Primesource Nursing Services, Inc |
|---|---|
| Speciality | Nurse Practitioner - Psychiatric/mental Health |
| Location | 1500 Broad Ave, Gulfport, Mississippi |
| Authorized Official Name and Position | Rhett Plauche (PRESIDENT) |
| Authorized Official Contact | 2288651330 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Primesource Nursing Services, Inc Po Box 6705 Gulfport MS 39506-6705 Ph: (228) 865-1330 | Primesource Nursing Services, Inc 1500 Broad Ave Gulfport MS 39501-3601 Ph: (228) 865-1330 |
| NPI Number | 1952884652 |
|---|---|
| Provider Enumeration Date | 09/10/2018 |
| Last Update Date | 09/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952884652 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
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