Healthcare Provider Details

I. General information

NPI: 1568020675
Provider Name (Legal Business Name): EMILY HARBARGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 W GOVERNMENT ST
BRANDON MS
39042-3048
US

IV. Provider business mailing address

PO BOX 23666
JACKSON MS
39225-3666
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-4790
  • Fax: 601-200-4855
Mailing address:
  • Phone: 601-200-4790
  • Fax: 601-200-4855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01191215
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: