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General NPI Number Information
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NPI Number | 1194745315
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Entity Type | Individual
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Provider Name | MICHELE BRYANT MAHAFFEY FNP
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Gender | Female
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 1014 ROSE ST SUITE A
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City | PRENTISS
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State | MS
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Zip | 39474-5271
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Country | US
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Telephone | 601-792-2200
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Fax | 601-792-2345
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Provider Business Mailing Address
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Address Line | PO BOX 667 1014 ROSE STREET SUITE A
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City | PRENTISS
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State | MS
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Zip | 39474-0667
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Country | US
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Telephone | 601-792-2200
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Fax | 601-792-2345
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R667552
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License Number State | MS
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