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General NPI Number Information
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NPI Number | 1952717274
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Entity Type | Individual
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Provider Name | BROOK CHANNELLE HUNTER AGACNP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 2500 N STATE ST CARDIOVASCULAR INTENSIVE CARE UNIT
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-1575
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Fax | 601-815-1577
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Provider Business Mailing Address
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Address Line | 2500 N STATE ST CARDIOVASCULAR INTENSIVE CARE UNIT
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-1575
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Fax | 601-815-1577
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R880244
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License Number State | MS
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