=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598438483
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FULUMIRANI MCCOY NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2021
-----------------------------------------------------
Last Update Date | 08/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 571 MITCHELL ST STE C
-----------------------------------------------------
City | GUNTOWN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38849-8500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-348-3342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1031 COUNTY ROAD 194
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38828-9102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-255-6879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 904010
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------