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General NPI Number Information
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NPI Number | 1992223887
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Entity Type | Individual
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Provider Name | ALISSA NICHOLAS DAMIENS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 230 WYETH LN
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City | YAZOO CITY
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State | MS
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Zip | 39194-4653
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Country | US
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Telephone | 662-746-8962
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Fax | 662-746-8964
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Provider Business Mailing Address
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Address Line | 3328 MYRLEVILLE RD
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City | YAZOO CITY
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State | MS
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Zip | 39194-9530
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Country | US
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Telephone | 662-571-2911
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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 | 902276
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License Number State | MS
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