Provider Demographics
NPI:1235857236
Name:BAHADUR, DEVINNA (DNP, MSN, AGACN-BC)
Entity Type:Individual
Prefix:DR
First Name:DEVINNA
Middle Name:
Last Name:BAHADUR
Suffix:
Gender:F
Credentials:DNP, MSN, AGACN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 S FRONTAGE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5882
Mailing Address - Country:US
Mailing Address - Phone:601-564-7070
Mailing Address - Fax:601-636-6233
Practice Address - Street 1:2080 S FRONTAGE RD STE 107
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5882
Practice Address - Country:US
Practice Address - Phone:601-564-7070
Practice Address - Fax:601-636-6233
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902332363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner