Healthcare Provider Details

I. General information

NPI: 1992881882
Provider Name (Legal Business Name): BETHANY LEE GRECO CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40023 CROSS CREEK DR
HAMILTON MS
39746-8801
US

IV. Provider business mailing address

40023 CROSS CREEK DR
HAMILTON MS
39746-8801
US

V. Phone/Fax

Practice location:
  • Phone: 662-343-5299
  • Fax: 662-343-9087
Mailing address:
  • Phone: 662-343-5299
  • Fax: 662-343-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR800666
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: