Healthcare Provider Details

I. General information

NPI: 1467778423
Provider Name (Legal Business Name): LEANNE TERRELL BYNUM FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEANNE TERRELL DAVIS FNP-BC

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 S SIXTH ST # A
BAY SPRINGS MS
39422-9052
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-764-2155
  • Fax: 601-764-2150
Mailing address:
  • Phone: 601-545-3700
  • Fax: 601-450-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR793779
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: