Healthcare Provider Details

I. General information

NPI: 1134164916
Provider Name (Legal Business Name): HEATHER LLOYD CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BAKER BLVD
LELAND MS
38756
US

IV. Provider business mailing address

201 BAKER BLVD
LELAND MS
38756-3401
US

V. Phone/Fax

Practice location:
  • Phone: 662-686-4121
  • Fax: 662-686-4770
Mailing address:
  • Phone: 662-686-4121
  • Fax: 662-686-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR862588
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: