Healthcare Provider Details

I. General information

NPI: 1528475217
Provider Name (Legal Business Name): YOSHIE SHERAY LILLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 09/24/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 MS HIGHWAY 15
ACKERMAN MS
39735-3973
US

IV. Provider business mailing address

PO BOX 242
ACKERMAN MS
39735-0242
US

V. Phone/Fax

Practice location:
  • Phone: 662-387-7167
  • Fax:
Mailing address:
  • Phone: 662-387-7167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR874350
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR874350
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: