Provider Demographics
NPI:1083186563
Name:SHUMPERT, EURIEKA DENISE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:EURIEKA
Middle Name:DENISE
Last Name:SHUMPERT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 COUNTY ROAD 154
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:MS
Mailing Address - Zip Code:38868-9190
Mailing Address - Country:US
Mailing Address - Phone:662-397-6099
Mailing Address - Fax:
Practice Address - Street 1:1136 COUNTY ROAD 154
Practice Address - Street 2:
Practice Address - City:SHANNON
Practice Address - State:MS
Practice Address - Zip Code:38868-9190
Practice Address - Country:US
Practice Address - Phone:662-397-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily