Provider Demographics
NPI:1184861320
Name:MISSISSIPPI NURSE PRACTITIONERS INC
Entity type:Organization
Organization Name:MISSISSIPPI NURSE PRACTITIONERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-941-5497
Mailing Address - Street 1:441 KINGSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7644
Mailing Address - Country:US
Mailing Address - Phone:601-941-5497
Mailing Address - Fax:601-866-7773
Practice Address - Street 1:441 KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7644
Practice Address - Country:US
Practice Address - Phone:601-941-5497
Practice Address - Fax:601-866-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR652075363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty