Healthcare Provider Details

I. General information

NPI: 1942467337
Provider Name (Legal Business Name): SUSAN PRATHER CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E SUNFLOWER RD STE 5
CLEVELAND MS
38732-2715
US

IV. Provider business mailing address

201 E SUNFLOWER RD STE 5
CLEVELAND MS
38732-2715
US

V. Phone/Fax

Practice location:
  • Phone: 662-545-4599
  • Fax: 833-953-0023
Mailing address:
  • Phone: 662-545-4599
  • Fax: 833-953-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR874318
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: