=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740761956
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YAKITTA LANDRUM-LOVETT NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2018
-----------------------------------------------------
Last Update Date | 08/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 559A HIGHWAY 1 N
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38701-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-702-5159
-----------------------------------------------------
Fax | 662-702-5167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 GREEN TREE TRL
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38701-8077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-579-6698
-----------------------------------------------------
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 | 902674
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------