Healthcare Provider Details

I. General information

NPI: 1194157784
Provider Name (Legal Business Name): SARA MARIE PRESLEY MSN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

109 MEMORY LN
MADISON MS
39110-6866
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-7100
  • Fax:
Mailing address:
  • Phone: 601-918-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberR882659
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: