Healthcare Provider Details

I. General information

NPI: 1639614563
Provider Name (Legal Business Name): FAYE ANN ROBERTSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. FAYE ANN COLOM

II. Dates (important events)

Enumeration Date: 01/02/2017
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 MILITARY RD
COLUMBUS MS
39701-4670
US

IV. Provider business mailing address

326 MILITARY RD
COLUMBUS MS
39701-4670
US

V. Phone/Fax

Practice location:
  • Phone: 662-251-5664
  • Fax:
Mailing address:
  • Phone: 662-251-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number901827
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901827
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: