Healthcare Provider Details

I. General information

NPI: 1881797330
Provider Name (Legal Business Name): TERRILYN LEWIS NP-C, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRILYN LEGGETT NP-C

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MARION AVE
MCCOMB MS
39648-2709
US

IV. Provider business mailing address

405 MARION AVE
MCCOMB MS
39648-2709
US

V. Phone/Fax

Practice location:
  • Phone: 601-684-1250
  • Fax: 601-684-0129
Mailing address:
  • Phone: 601-684-1250
  • Fax: 601-684-0129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR853385
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: