Provider Demographics
NPI:1114427515
Name:TRULY, NATWASSIE (FNPC)
Entity Type:Individual
Prefix:
First Name:NATWASSIE
Middle Name:
Last Name:TRULY
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GREER CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-6014
Mailing Address - Country:US
Mailing Address - Phone:601-832-5548
Mailing Address - Fax:
Practice Address - Street 1:1883 HIGHWAY 43 S STE E
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8406
Practice Address - Country:US
Practice Address - Phone:769-231-7499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00320311Medicaid