Provider Demographics
NPI:1114127099
Name:FARRELL, GEORGE EDWARD (FNP)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EDWARD
Last Name:FARRELL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 POPLAR STREET
Mailing Address - Street 2:P.O. BOX 347
Mailing Address - City:MARKS
Mailing Address - State:MS
Mailing Address - Zip Code:38646-0347
Mailing Address - Country:US
Mailing Address - Phone:662-326-9232
Mailing Address - Fax:662-326-8851
Practice Address - Street 1:411 POPLAR STREET
Practice Address - Street 2:
Practice Address - City:MARKS
Practice Address - State:MS
Practice Address - Zip Code:38646-0347
Practice Address - Country:US
Practice Address - Phone:662-326-9232
Practice Address - Fax:662-326-8851
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR615625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily