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General NPI Number Information
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NPI Number | 1326768854
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Entity Type | Individual
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Provider Name | DANIELLE DIANE LEWIS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 623 W MAIN ST
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City | TUPELO
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State | MS
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Zip | 38804-3759
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Country | US
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Telephone | 662-397-7794
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Fax |
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Provider Business Mailing Address
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Address Line | 4174 HIGHWAY 278
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City | SULLIGENT
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State | AL
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Zip | 35586-4525
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Country | US
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Telephone | 205-712-5114
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 905531
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License Number State | MS
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