MEDICARE: LINDA LAMISON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R640492	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73103350	OTHER	AL	BCBS OF ALABAMA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	640908592	OTHER	MS	TAX ID

General Provider Information

NPI Number	:	1831194364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA LAMISON NP

Provider Business Mailing Address
First Line	:	2110 LAKE LOWNDES RD
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-9655
Country	:	US
Telephone Number	:	662-329-4940
Fax Number	:	662-329-4928

Provider Business Practice Location Address
First Line	:	2110 LAKE LOWNDES RD
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39702-9655
Country	:	US
Telephone Number	:	662-329-4940
Fax Number	:	662-329-4928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/09/2007

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