Healthcare Provider Details

I. General information

NPI: 1235857236
Provider Name (Legal Business Name): DEVINNA BAHADUR DNP, MSN, AGACN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 S FRONTAGE RD STE 107
VICKSBURG MS
39180-5882
US

IV. Provider business mailing address

2080 S FRONTAGE RD STE 107
VICKSBURG MS
39180-5882
US

V. Phone/Fax

Practice location:
  • Phone: 601-564-7070
  • Fax: 601-636-6233
Mailing address:
  • Phone: 601-564-7070
  • Fax: 601-636-6233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number902332
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: