Healthcare Provider Details

I. General information

NPI: 1982484242
Provider Name (Legal Business Name): LINDA VANESSA YAUL ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7048 OLD CANTON RD STE 2E
RIDGELAND MS
39157-1021
US

IV. Provider business mailing address

100 HIDDEN HILLS CIR
BRANDON MS
39047-4541
US

V. Phone/Fax

Practice location:
  • Phone: 601-919-0972
  • Fax:
Mailing address:
  • Phone: 931-561-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number906270
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: