Healthcare Provider Details

I. General information

NPI: 1851000889
Provider Name (Legal Business Name): CHASITY BROOKE FLOURNOY C-PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 GRANDSTAND PLACE SUITE 101
TUPELO MS
38804
US

IV. Provider business mailing address

808 VARSITY DR
TUPELO MS
38801-4613
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-7337
  • Fax: 662-842-1350
Mailing address:
  • Phone: 662-377-2774
  • Fax: 662-377-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number907052
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: