Healthcare Provider Details

I. General information

NPI: 1669245411
Provider Name (Legal Business Name): WARREN COLE CREEL AGACNP-BC, RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 BURNEY DR
FLOWOOD MS
39232-6621
US

IV. Provider business mailing address

104 BURNEY DR
FLOWOOD MS
39232-6621
US

V. Phone/Fax

Practice location:
  • Phone: 601-803-7933
  • Fax:
Mailing address:
  • Phone: 601-987-8200
  • Fax: 601-987-8211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number907807
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-186474
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: