Healthcare Provider Details

I. General information

NPI: 1831857374
Provider Name (Legal Business Name): LEE VESTER CALVERT JR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 03/01/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 HIGHWAY 278 E STE A
AMORY MS
38821-5906
US

IV. Provider business mailing address

1139 SEED TICK RD
CALEDONIA MS
39740-9516
US

V. Phone/Fax

Practice location:
  • Phone: 662-597-2019
  • Fax: 662-597-2034
Mailing address:
  • Phone: 662-251-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906020
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: