Provider Demographics
NPI:1063644599
Name:UPCHURCH, AGNES PAMELA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:PAMELA
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:1350 SUNSET DR
Mailing Address - Street 2:STE B
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4079
Mailing Address - Country:US
Mailing Address - Phone:662-229-0669
Mailing Address - Fax:662-227-9929
Practice Address - Street 1:1350 SUNSET DR
Practice Address - Street 2:STE B
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4079
Practice Address - Country:US
Practice Address - Phone:662-229-0669
Practice Address - Fax:662-227-9929
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2020-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MSR797137363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily