Healthcare Provider Details

I. General information

NPI: 1942471115
Provider Name (Legal Business Name): JAMES HAROLD SHIVERS II FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S HOLLY AVE
COLLINS MS
39428-3894
US

IV. Provider business mailing address

2817 GATES RD
BASSFIELD MS
39421-9026
US

V. Phone/Fax

Practice location:
  • Phone: 601-765-3180
  • Fax: 601-765-2808
Mailing address:
  • Phone: 601-765-3180
  • Fax: 601-765-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR813646
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: