Basic Information
| Provider Information | |||||||||
| NPI: | 1245348689 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARISH | ||||||||
| FirstName: | NANCI | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5959 S SHERWOOD FOREST BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708166038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257655727 | ||||||||
| FaxNumber: | 2257659691 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 A HWY 11 NORTH | ||||||||
| Address2: | |||||||||
| City: | PICAYUNE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394660419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017993130 | ||||||||
| FaxNumber: | 6017993132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2006 | ||||||||
| LastUpdateDate: | 05/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R619442 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 619442 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1053544155 | 01 | MS | GOUP: LIGHTHOUSE HEALTHCARE NANCI PARISH LLC | OTHER | 264793184 | 01 | MS | TAXONOMY | OTHER | 640507572VW | 01 | MS | AMERICAN ADMIN GROUP | OTHER | 00117683 | 05 | MS | MEDICAID | 1001384 | 05 | LA | MEDICAID |