Healthcare Provider Details

I. General information

NPI: 1982177176
Provider Name (Legal Business Name): CLIFTON WESLEY CARTWRIGHT FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 E CHURCH ST
BOONEVILLE MS
38829-3709
US

IV. Provider business mailing address

517 E CHURCH ST
BOONEVILLE MS
38829-3709
US

V. Phone/Fax

Practice location:
  • Phone: 662-728-8136
  • Fax: 888-510-7960
Mailing address:
  • Phone: 662-728-8136
  • Fax: 888-510-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903111
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: