MEDICARE: VANESSA HAYWOOD FNP

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	903804	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER		NO NUMBER

General Provider Information

NPI Number	:	1700417961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA HAYWOOD FNP

Provider Business Mailing Address
First Line	:	1167 AVON PL
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-8306
Country	:	US
Telephone Number	:	662-721-6006
Fax Number	:	662-257-8833

Provider Business Practice Location Address
First Line	:	1440 HIGHWAY 1 S
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-7140
Country	:	US
Telephone Number	:	662-235-9746
Fax Number	:	662-674-9156

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

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	05/07/2026

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