Healthcare Provider Details

I. General information

NPI: 1386677474
Provider Name (Legal Business Name): LUCY NJOROGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E FRONTAGE RD
SARDIS MS
38666-1339
US

IV. Provider business mailing address

177 PARKWAY CV W
HERNANDO MS
38632-1627
US

V. Phone/Fax

Practice location:
  • Phone: 662-487-3938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR844344
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: