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General NPI Number Information
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NPI Number | 1528558061
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Entity Type | Individual
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Provider Name | DEERA WARREN MSN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 7601 SOUTHCREST PKWY
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City | SOUTHAVEN
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State | MS
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Zip | 38671
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Country | US
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Telephone | 662-772-3260
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Fax |
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Provider Business Mailing Address
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Address Line | 6576 PAYNE LN
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-9192
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Country | US
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Telephone |
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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 | F02180313
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 902552
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License Number State | MS
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