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General NPI Number Information
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NPI Number | 1851622120
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Entity Type | Individual
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Provider Name | MARSHA LYNN AUSTIN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 3502 W NORTHSIDE DR
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City | JACKSON
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State | MS
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Zip | 39213-4454
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Country | US
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Telephone | 601-362-5321
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Fax |
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Provider Business Mailing Address
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Address Line | 4311 BLAINE CIR
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City | BYRAM
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State | MS
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Zip | 39272-4475
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Country | US
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Telephone | 601-376-0856
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R867239
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License Number State | MS
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