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NPI Code Detail

MEDICARE: PRISCILLA ELIZABETH PULLIAM N.P.

MEDICARE: PRISCILLA ELIZABETH PULLIAM N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner865613MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114975505
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRISCILLA ELIZABETH PULLIAM N.P.
Provider Business Mailing Address
First Line : 2500 NORTH STATE STREET
Second Line : JMM ROOM 2525
City : JACKSON
State : MS
Zip : 39216-4500
Country : US
Telephone Number : 601-984-6426
Fax Number : 601-984-6439
Provider Business Practice Location Address
First Line : 1030 RIVER OAKS DR
Second Line :
City : JACKSON
State : MS
Zip : 39232-9553
Country : US
Telephone Number : 601-924-3719
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 05/23/2023

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