=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396776514
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH A HOOVER DNP,FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 10/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4077 PEMBERTON SQUARE BLVD
-----------------------------------------------------
City | VICKSBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39180-5580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-638-8600
-----------------------------------------------------
Fax | 601-638-8661
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4077 PEMBERTON SQUARE BLVD
-----------------------------------------------------
City | VICKSBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39180-5580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-638-8600
-----------------------------------------------------
Fax | 601-638-8661
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | R764566
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | R764566
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------