Healthcare Provider Details

I. General information

NPI: 1629627542
Provider Name (Legal Business Name): HANNAH SCHLATTER FARMER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 N OAK AVE
RULEVILLE MS
38771-3227
US

IV. Provider business mailing address

406 E PERCY ST
INDIANOLA MS
38751-2544
US

V. Phone/Fax

Practice location:
  • Phone: 662-756-4024
  • Fax:
Mailing address:
  • Phone: 662-207-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903428
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: