Healthcare Provider Details

I. General information

NPI: 1164089322
Provider Name (Legal Business Name): PAULA PERTEET FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 KATHERINE DR STE A
FLOWOOD MS
39232-9588
US

IV. Provider business mailing address

22741 HIGHWAY 12
LEXINGTON MS
39095-3118
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 855-830-3484
Mailing address:
  • Phone: 662-834-1961
  • Fax: 662-834-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number903318
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: