Healthcare Provider Details

I. General information

NPI: 1407594443
Provider Name (Legal Business Name): ERIN ELIZABETH WARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 E MAIN ST
TUPELO MS
38804-2956
US

IV. Provider business mailing address

7946 HIGHWAY 6 W
PONTOTOC MS
38863-9144
US

V. Phone/Fax

Practice location:
  • Phone: 662-350-3550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905223
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: