Healthcare Provider Details

I. General information

NPI: 1831194364
Provider Name (Legal Business Name): LINDA LAMISON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 LAKE LOWNDES RD
COLUMBUS MS
39702-9655
US

IV. Provider business mailing address

2110 LAKE LOWNDES RD
COLUMBUS MS
39702-9655
US

V. Phone/Fax

Practice location:
  • Phone: 662-329-4940
  • Fax: 662-329-4928
Mailing address:
  • Phone: 662-329-4940
  • Fax: 662-329-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR640492
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: