Healthcare Provider Details

I. General information

NPI: 1669829594
Provider Name (Legal Business Name): JOY ALLEN PRICE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 COUNTY ROAD 436
RIENZI MS
38865-9776
US

IV. Provider business mailing address

15 COUNTY ROAD 436
RIENZI MS
38865-9776
US

V. Phone/Fax

Practice location:
  • Phone: 662-462-7711
  • Fax:
Mailing address:
  • Phone: 662-462-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18195
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: