Provider Demographics
NPI:1265443063
Name:SERIO, JOSE A (FNP)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:SERIO
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 1:307 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4610
Mailing Address - Country:US
Mailing Address - Phone:601-392-0404
Mailing Address - Fax:601-653-0352
Practice Address - Street 1:307 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4610
Practice Address - Country:US
Practice Address - Phone:601-392-1672
Practice Address - Fax:601-653-0352
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851134207Q00000X, 207R00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
500001480Medicare ID - Type Unspecified
P65857Medicare UPIN