Healthcare Provider Details

I. General information

NPI: 1932397908
Provider Name (Legal Business Name): VANESSA WINTER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S GLOSTER ST 4TH FLOOR EAST TOWER
TUPELO MS
38801-4934
US

IV. Provider business mailing address

450 E PRESIDENT AVE
TUPELO MS
38801-5599
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-7150
  • Fax: 662-377-7155
Mailing address:
  • Phone: 662-377-4685
  • Fax: 662-377-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR867416
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: