Healthcare Provider Details

I. General information

NPI: 1417133083
Provider Name (Legal Business Name): MICHELLE VINCHWATER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 LIBERTY RD
FLOWOOD MS
39232-9321
US

IV. Provider business mailing address

4921 COURTHOUSE RD
GULFPORT MS
39507-4246
US

V. Phone/Fax

Practice location:
  • Phone: 769-243-6141
  • Fax:
Mailing address:
  • Phone: 601-540-1045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR860390
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: