MEDICARE: SUSAN PRATHER 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	R874318	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	:	1942467337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PRATHER CFNP

Provider Business Mailing Address
First Line	:	580 FRIARS POINT RD
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-9734
Country	:	US
Telephone Number	:	662-624-4316
Fax Number	:	662-627-2758

Provider Business Practice Location Address
First Line	:	580 FRIARS POINT RD
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-9734
Country	:	US
Telephone Number	:	662-624-4316
Fax Number	:	662-621-1151

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	06/14/2017

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