MEDICARE: MRS. VANITA PHINISEY NP-C

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	363LF0000X	Family Nurse Practitioner	F0611220	MS

General Provider Information

NPI Number	:	1518254580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANITA PHINISEY NP-C

Provider Business Mailing Address
First Line	:	30 BURTON HILLS BLVD STE 175
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-6403
Country	:	US
Telephone Number	:	615-988-2016
Fax Number	:	615-523-8411

Provider Business Practice Location Address
First Line	:	1503 HIGHWAY 45 N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2113
Country	:	US
Telephone Number	:	662-328-9623
Fax Number	:	662-327-7477

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

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	07/23/2020

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