Basic Information
Provider Information
NPI: 1245424787
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MYERS
FirstName: NATALIE
MiddleName: BUSBEE
NamePrefix:  
NameSuffix:  
Credential: CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13 NORTHTOWN DR
Address2: SUITE 110
City: JACKSON
State: MS
PostalCode: 392113047
CountryCode: US
TelephoneNumber: 6012069195
FaxNumber: 6019578391
Practice Location
Address1: 13 NORTHTOWN DR
Address2: SUITE 110
City: JACKSON
State: MS
PostalCode: 392113047
CountryCode: US
TelephoneNumber: 6012069195
FaxNumber: 6019578391
Other Information
ProviderEnumerationDate: 08/28/2007
LastUpdateDate: 08/28/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XS2530MSY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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