MEDICARE: MR. NOEL ANTHONY LUNSFORD NP

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
1	363L00000X	Nurse Practitioner	A116795	IA
2	363LF0000X	Family Nurse Practitioner	R878488	MS

Other Identifiers

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

General Provider Information

NPI Number	:	1316942790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NOEL ANTHONY LUNSFORD NP

Provider Business Mailing Address
First Line	:	290 HIGHWAY 51 N
Second Line	:
City	:	BROOKHAVEN
State	:	MS
Zip	:	39601-2654
Country	:	US
Telephone Number	:	601-823-1710
Fax Number	:	601-825-8130

Provider Business Practice Location Address
First Line	:	290 HIGHWAY 51 N
Second Line	:
City	:	BROOKHAVEN
State	:	MS
Zip	:	39601-2654
Country	:	US
Telephone Number	:	601-823-1710
Fax Number	:	601-825-8130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	06/19/2013

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