Healthcare Provider Details

I. General information

NPI: 1316924079
Provider Name (Legal Business Name): LINDA BOND FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGHWAY 535
SEMINARY MS
39479-8809
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-722-3208
  • Fax: 601-722-3304
Mailing address:
  • Phone: 601-545-8700
  • Fax: 601-582-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR724564
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: