Healthcare Provider Details

I. General information

NPI: 1003449398
Provider Name (Legal Business Name): NATHANIEL LEVI BUMP FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2020
Last Update Date: 07/11/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 SOUTHCREST PKWY STE 109
SOUTHAVEN MS
38671-4852
US

IV. Provider business mailing address

7111 SOUTHCREST PKWY STE 109
SOUTHAVEN MS
38671-4852
US

V. Phone/Fax

Practice location:
  • Phone: 662-503-7416
  • Fax: 662-349-9082
Mailing address:
  • Phone: 662-349-9116
  • Fax: 662-349-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number27228
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903864
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: