Healthcare Provider Details

I. General information

NPI: 1083432025
Provider Name (Legal Business Name): HAYDEN HUDSPETH TRANUM FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 5TH ST N
COLUMBUS MS
39705-2008
US

IV. Provider business mailing address

2520 5TH ST N
COLUMBUS MS
39705-2008
US

V. Phone/Fax

Practice location:
  • Phone: 662-244-1000
  • Fax:
Mailing address:
  • Phone: 662-244-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906919
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: