Healthcare Provider Details

I. General information

NPI: 1871674713
Provider Name (Legal Business Name): SUSAN DUFFIE CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN DUFFIE-MORGAN CFNP

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 GLOSTER CREEK VLG SUITE A-3
TUPELO MS
38801-4600
US

IV. Provider business mailing address

2434 S EASON BLVD
TUPELO MS
38804-6942
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-1717
  • Fax: 662-680-6416
Mailing address:
  • Phone: 662-844-1717
  • Fax: 662-680-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR777236
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: