Provider Demographics
NPI:1316290935
Name:MYERS, VERLENCIA R (RN)
Entity type:Individual
Prefix:MRS
First Name:VERLENCIA
Middle Name:R
Last Name:MYERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JETUWAN
Other - Middle Name:M
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:102 AMETHYST LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6375
Mailing Address - Country:US
Mailing Address - Phone:601-559-9071
Mailing Address - Fax:
Practice Address - Street 1:102 AMETHYST LN
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6375
Practice Address - Country:US
Practice Address - Phone:601-559-9071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR876299163W00000X
376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide