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General NPI Number Information
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NPI Number | 1962708347
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Entity Type | Individual
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Provider Name | MISTY D. MAYFIELD FNP
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Gender | Female
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 2514 67TH AVENUE LOOP SUITE 112
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City | MERIDIAN
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State | MS
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Zip | 39307-7259
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Country | US
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Telephone | 601-553-0707
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Fax | 601-553-0775
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Provider Business Mailing Address
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Address Line | PO BOX 2839
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City | MERIDIAN
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State | MS
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Zip | 39302-2839
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Country | US
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Telephone | 601-553-0707
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Fax | 601-553-0775
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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 | R864583
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License Number State | MS
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