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General NPI Number Information
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NPI Number | 1821505769
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Entity Type | Individual
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Provider Name | TONYA BRISTER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/31/2017
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 521 MARION AVE
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City | MCCOMB
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State | MS
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Zip | 39648-2009
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Country | US
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Telephone | 601-600-2053
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Fax |
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Provider Business Mailing Address
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Address Line | 139 THORNHILL RD
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City | JAYESS
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State | MS
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Zip | 39641-8028
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Country | US
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Telephone | 601-303-6144
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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 | 902478
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License Number State | MS
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