Provider Demographics
NPI:1992263685
Name:JAMES, NADINE THERESA (CRNP-BC)
Entity type:Individual
Prefix:DR
First Name:NADINE
Middle Name:THERESA
Last Name:JAMES
Suffix:
Gender:F
Credentials:CRNP-BC
Other - Prefix:MISS
Other - First Name:NADINE
Other - Middle Name:THERESA
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1214 VELMA ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2751
Mailing Address - Country:US
Mailing Address - Phone:228-216-4210
Mailing Address - Fax:
Practice Address - Street 1:1214 VELMA ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2751
Practice Address - Country:US
Practice Address - Phone:228-216-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902758363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology