Healthcare Provider Details

I. General information

NPI: 1992423602
Provider Name (Legal Business Name): DANA FAITH GILBERT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 COBBLESTONE BLVD S
SOUTHAVEN MS
38672-7075
US

IV. Provider business mailing address

3495 COBBLESTONE BLVD S
SOUTHAVEN MS
38672-7075
US

V. Phone/Fax

Practice location:
  • Phone: 662-892-2885
  • Fax: 662-890-1551
Mailing address:
  • Phone: 662-892-2885
  • Fax: 662-890-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904260
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: