Healthcare Provider Details

I. General information

NPI: 1568200673
Provider Name (Legal Business Name): SANDRA LINDSEY POPE SRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA LINDSEY FERGUSON BSN, RN

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 14TH ST
MERIDIAN MS
39301-4040
US

IV. Provider business mailing address

1130 WOODLAWN ST
TUPELO MS
38804-2504
US

V. Phone/Fax

Practice location:
  • Phone: 601-553-6000
  • Fax:
Mailing address:
  • Phone: 601-616-8079
  • Fax: 601-616-8079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: