MEDICARE: NANCY F EASTERLING CFNP

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	R629626	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

General Provider Information

NPI Number	:	1568486124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY F EASTERLING CFNP

Provider Business Mailing Address
First Line	:	914 SUMRALL RD
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-2652
Country	:	US
Telephone Number	:	601-731-1470
Fax Number	:	601-731-1474

Provider Business Practice Location Address
First Line	:	914 SUMRALL RD
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-2652
Country	:	US
Telephone Number	:	601-731-1470
Fax Number	:	601-731-1474

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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