| The Nordal Clinic, Pa | |
|
1121 Grove St Vicksburg MS 39183-2913 | |
| (601) 634-0118 | |
| (601) 630-0302 |
| Full Name | The Nordal Clinic, Pa |
|---|---|
| Speciality | Psychologist |
| Location | 1121 Grove St, Vicksburg, Mississippi |
| Authorized Official Name and Position | Katherine C Nordal (PRESIDENT) |
| Authorized Official Contact | 6016340118 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Nordal Clinic, Pa 1121 Grove St Vicksburg MS 39183-2913 Ph: (601) 634-0118 | The Nordal Clinic, Pa 1121 Grove St Vicksburg MS 39183-2913 Ph: (601) 634-0118 |
| NPI Number | 1558483743 |
|---|---|
| Provider Enumeration Date | 04/06/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6103087499 |
|---|---|
| Medicare Enrollment ID | O20120412000745 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558483743 | NPI | - | NPPES |
| 09011887 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TH0100X | Psychologist - Health Service | (Mississippi) | Primary |
| Provider Name | Angela Jeanne Koestler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942391180 PECOS PAC ID: 7911168208 Enrollment ID: I20120412000756 |
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