Healthcare Provider Details

I. General information

NPI: 1962239970
Provider Name (Legal Business Name): PAIGE H. DEDMON WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 RIVER OAKS DR STE 320
FLOWOOD MS
39232-9512
US

IV. Provider business mailing address

1020 RIVER OAKS DR STE 320
FLOWOOD MS
39232-9512
US

V. Phone/Fax

Practice location:
  • Phone: 601-936-1400
  • Fax: 601-936-1416
Mailing address:
  • Phone: 601-896-4720
  • Fax: 601-936-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number908855
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: