Healthcare Provider Details

I. General information

NPI: 1487689063
Provider Name (Legal Business Name): DIANA DICKSON LITTLE RN,MSN,CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E.WOODROW WILSON G.V. 'SONNY' MONTGOMERY MEDICAL CENTER
JACKSON MS
39216
US

IV. Provider business mailing address

1018 GERRITS LNDG
BRANDON MS
39047-7755
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-4471
  • Fax: 601-364-1327
Mailing address:
  • Phone: 601-362-4471
  • Fax: 601-364-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR516252
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: