Provider Demographics
NPI:1437847381
Name:SEARD, IKKIA
Entity type:Individual
Prefix:MISS
First Name:IKKIA
Middle Name:
Last Name:SEARD
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:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38769-0706
Mailing Address - Country:US
Mailing Address - Phone:662-926-1322
Mailing Address - Fax:
Practice Address - Street 1:43 TOWN CENTER SQ STE 102
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7040
Practice Address - Country:US
Practice Address - Phone:800-945-9479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator