MEDICARE: COLTON DUNN FNP-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	34265	TN
2	363LF0000X	Family Nurse Practitioner	F06230714	MS

General Provider Information

NPI Number	:	1568841088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLTON DUNN FNP-C

Provider Business Mailing Address
First Line	:	6518 GOODMAN RD STE 104
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-9809
Country	:	US
Telephone Number	:	662-420-7350
Fax Number	:

Provider Business Practice Location Address
First Line	:	6518 GOODMAN RD STE 104
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-9809
Country	:	US
Telephone Number	:	662-420-7350
Fax Number	:

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

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	07/19/2023

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Directions to “ COLTON DUNN FNP-C” Practice Location

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