Healthcare Provider Details

I. General information

NPI: 1285016279
Provider Name (Legal Business Name): MAGAN L SHIPP C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 EUREKA ST
BATESVILLE MS
38606-2533
US

IV. Provider business mailing address

107 EUREKA ST
BATESVILLE MS
38606-2533
US

V. Phone/Fax

Practice location:
  • Phone: 662-563-7681
  • Fax: 662-563-2611
Mailing address:
  • Phone: 662-563-7681
  • Fax: 662-563-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR883141
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: