Healthcare Provider Details

I. General information

NPI: 1801178611
Provider Name (Legal Business Name): DOVIE CHRISTINE PRYOR RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 AUTUMN OAKS DR
OLIVE BRANCH MS
38654-6611
US

IV. Provider business mailing address

6105 AUTUMN OAKS DR
OLIVE BRANCH MS
38654-6611
US

V. Phone/Fax

Practice location:
  • Phone: 901-603-3119
  • Fax:
Mailing address:
  • Phone: 901-603-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR875625
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: