Healthcare Provider Details

I. General information

NPI: 1356712525
Provider Name (Legal Business Name): MARY ELIZABETH POUNDERS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 COUNTY ROAD 408
CORINTH MS
38834-7705
US

IV. Provider business mailing address

703 ALCORN DR STE 109
CORINTH MS
38834-9302
US

V. Phone/Fax

Practice location:
  • Phone: 662-415-2460
  • Fax:
Mailing address:
  • Phone: 662-286-1499
  • Fax: 662-286-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberPOUN-HU9NWL
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: