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General NPI Number Information
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NPI Number | 1205922747
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Entity Type | Individual
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Provider Name | TAMI BIVINS JOHNSON FNP
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 603B HWY 365 BURNSVILLE MEDICAL CLINIC
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City | BURNSVILLE
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State | MS
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Zip | 38833
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Country | US
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Telephone | 662-427-9999
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Fax | 662-427-9977
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Provider Business Mailing Address
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Address Line | 2006 NORTH MADISON STREET
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City | CORINTH
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State | MS
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Zip | 38834
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Country | US
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Telephone | 662-287-6811
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Fax | 662-427-9977
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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 | R605972
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License Number State | MS
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