Healthcare Provider Details

I. General information

NPI: 1437230679
Provider Name (Legal Business Name): NANCY C BOATWRIGHT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 J M ASH DR
HOLLY SPRINGS MS
38635-3238
US

IV. Provider business mailing address

538 J M ASH DR
HOLLY SPRINGS MS
38635-3238
US

V. Phone/Fax

Practice location:
  • Phone: 662-333-6933
  • Fax: 662-333-6931
Mailing address:
  • Phone: 662-252-1599
  • Fax: 662-252-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR637181
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: