Healthcare Provider Details

I. General information

NPI: 1184080640
Provider Name (Legal Business Name): JOSHUA MINGA NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BAPTIST MEMORIAL CIR STE 202
OXFORD MS
38655-4476
US

IV. Provider business mailing address

202 MAIN ST
ECRU MS
38841-9604
US

V. Phone/Fax

Practice location:
  • Phone: 662-227-3255
  • Fax: 662-636-2451
Mailing address:
  • Phone: 662-489-4345
  • Fax: 662-489-8975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901386
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: