=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285135228
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRI LYNN BYRD FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2018
-----------------------------------------------------
Last Update Date | 08/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1220 JEFFERSON ST
-----------------------------------------------------
City | LAUREL
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39440-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-426-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 188 SULLIVAN KILRAIN RD
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39402-9022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-549-7005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 902520
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 902520
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------