Healthcare Provider Details

I. General information

NPI: 1063348928
Provider Name (Legal Business Name): DEISHA MUIRHEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3823 HIGHWAY 80 E STE 200
PEARL MS
39208-4272
US

IV. Provider business mailing address

3823 HIGHWAY 80 E STE 200
PEARL MS
39208-4272
US

V. Phone/Fax

Practice location:
  • Phone: 769-223-3261
  • Fax:
Mailing address:
  • Phone: 769-223-3261
  • Fax: 601-414-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number908515
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: