Healthcare Provider Details

I. General information

NPI: 1275922502
Provider Name (Legal Business Name): MARILYN M HARRINGTON PHD, RN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6270
  • Fax: 601-815-1828
Mailing address:
  • Phone: 601-984-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG0914088
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: