Healthcare Provider Details

I. General information

NPI: 1558475723
Provider Name (Legal Business Name): BARBARA DEW CRISWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N COURT ST
SUMNER MS
38957-9710
US

IV. Provider business mailing address

PO BOX 27
CHARLESTON MS
38921-0027
US

V. Phone/Fax

Practice location:
  • Phone: 662-375-9989
  • Fax: 662-375-8762
Mailing address:
  • Phone: 662-647-5816
  • Fax: 662-647-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR532355
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: