Healthcare Provider Details

I. General information

NPI: 1649689548
Provider Name (Legal Business Name): DAYNA HAMM PRIDGEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAYNA MICHELLE HAMM NP-C

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SW 6TH AVE STE 1100
PORTLAND OR
97204-1153
US

IV. Provider business mailing address

PO BOX 291
TAYLORSVILLE MS
39168-0291
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 601-705-2897
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number881108
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: