Healthcare Provider Details

I. General information

NPI: 1255806329
Provider Name (Legal Business Name): DELOIS DARLENE ORTEGO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 12TH ST
MERIDIAN MS
39301-4158
US

IV. Provider business mailing address

3506 HIGHWAY 496
MERIDIAN MS
39301-8280
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-4065
  • Fax:
Mailing address:
  • Phone: 601-934-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902941
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: