Healthcare Provider Details

I. General information

NPI: 1619275237
Provider Name (Legal Business Name): TAMMY F. FAULKNER-CRAIG DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2011
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HIGHWAY 49 S SUITE 4
RICHLAND MS
39218-9425
US

IV. Provider business mailing address

414 CLEVELAND ST
FOREST MS
39074-3214
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-6400
  • Fax: 601-932-6437
Mailing address:
  • Phone: 601-398-7248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR870557
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: