Healthcare Provider Details

I. General information

NPI: 1033361233
Provider Name (Legal Business Name): LELOUISE TINDALL DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LAYFAIR DR STE 120
FLOWOOD MS
39232
US

IV. Provider business mailing address

1350 E WOODROW WILSON AVE
JACKSON MS
39216
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-0238
  • Fax: 601-932-4391
Mailing address:
  • Phone: 601-932-0238
  • Fax: 601-932-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR855506
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: