Healthcare Provider Details

I. General information

NPI: 1851364228
Provider Name (Legal Business Name): TINA D HIGHFILL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/22/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 CENTER ST STE B
RICHLAND MS
39218-4800
US

IV. Provider business mailing address

118 MULLHERRIN DR
MADISON MS
39110-4533
US

V. Phone/Fax

Practice location:
  • Phone: 769-233-7141
  • Fax:
Mailing address:
  • Phone: 601-407-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR676276
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: