Healthcare Provider Details

I. General information

NPI: 1821292046
Provider Name (Legal Business Name): JOHN CHRISTOPHER FUNKHOUSER N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 CALHOUN STATION PARKWAY
MADISON MS
39110
US

IV. Provider business mailing address

PO BOX 23666
JACKSON MS
39225-3666
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-4321
  • Fax: 601-859-0159
Mailing address:
  • Phone: 601-200-4749
  • Fax: 601-200-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR859048
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: