Provider Demographics
NPI:1861899437
Name:RAFF, GINGER
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:RAFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 GETWELL RD
Mailing Address - Street 2:SUITE 212-D
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7318
Mailing Address - Country:US
Mailing Address - Phone:662-895-6455
Mailing Address - Fax:662-895-6460
Practice Address - Street 1:5960 GETWELL RD
Practice Address - Street 2:SUITE 212-D
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7318
Practice Address - Country:US
Practice Address - Phone:662-895-6455
Practice Address - Fax:662-895-6460
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily