Healthcare Provider Details

I. General information

NPI: 1861452401
Provider Name (Legal Business Name): MARY ANNE MARCY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ANNE KENT APRN

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491A CRAFT ST
HOLLY SPRINGS MS
38635-3251
US

IV. Provider business mailing address

491A CRAFT ST
HOLLY SPRINGS MS
38635-3251
US

V. Phone/Fax

Practice location:
  • Phone: 662-252-6416
  • Fax: 662-252-3355
Mailing address:
  • Phone: 662-252-6416
  • Fax: 662-252-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR866369
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: