Healthcare Provider Details

I. General information

NPI: 1699241968
Provider Name (Legal Business Name): MISSY MARIE CUMMINGS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 VETERANS PKWY
COLUMBUS GA
31904-9001
US

IV. Provider business mailing address

5601 VETERANS PKWY
COLUMBUS GA
31904-9001
US

V. Phone/Fax

Practice location:
  • Phone: 706-321-6411
  • Fax:
Mailing address:
  • Phone: 256-347-2506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN9492435
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number22172
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5010846
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-084731
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN276118
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: