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General NPI Number Information
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NPI Number | 1992273072
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Entity Type | Individual
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Provider Name | ERNESTINE IVY NP
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Gender | Female
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 900 STARK RD
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City | STARKVILLE
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State | MS
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Zip | 39759-3613
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Country | US
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Telephone | 662-323-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 396 BILLY COLEMAN RD
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City | WEST POINT
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State | MS
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Zip | 39773-7134
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Country | US
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Telephone | 662-295-0151
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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 | 902734
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License Number State | MS
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