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General NPI Number Information
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NPI Number | 1689450520
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Entity Type | Individual
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Provider Name | POYU BAMBY PETTY FNP
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Gender | Female
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 216 OXFORD RD
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City | NEW ALBANY
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State | MS
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Zip | 38652-3115
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Country | US
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Telephone | 625-534-9042
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Fax | 662-534-9707
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Provider Business Mailing Address
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Address Line | 350 N HUMPHREYS BLVD
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City | MEMPHIS
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State | TN
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Zip | 38120-2177
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Country | US
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Telephone | 901-226-4003
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Fax | 901-227-8591
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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 | 906331
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number | R879298
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License Number State | MS
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