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General NPI Number Information
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NPI Number | 1295106326
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Entity Type | Individual
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Provider Name | CONSTANCE FAULKNER FNP
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Gender | Female
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 1100 HIGHWAY 16 E
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City | CARTHAGE
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State | MS
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Zip | 39051-4222
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Country | US
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Telephone | 601-267-1470
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Fax | 601-267-1469
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 103
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City | MEMPHIS
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State | TN
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Zip | 38120-9446
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Country | US
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Telephone | 901-227-3255
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Fax | 901-227-3591
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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 | R885749
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License Number State | MS
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