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General NPI Number Information
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NPI Number | 1306305487
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Entity Type | Individual
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Provider Name | LOLITA DENISE HARTLEY NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 1828 HOSPITAL DR
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City | JACKSON
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State | MS
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Zip | 39204-3410
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Country | US
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Telephone | 601-487-8594
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Fax | 601-487-8570
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Provider Business Mailing Address
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Address Line | 1445 CHERRY GROVE RD
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City | CRYSTAL SPRINGS
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State | MS
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Zip | 39059-8749
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Country | US
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Telephone | 601-316-1474
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 902992
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License Number State | MS
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