Provider Demographics
NPI:1346318441
Name:VERUCCHI, DEBORAH (CNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:VERUCCHI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:5740 GETWELL RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6346
Mailing Address - Country:US
Mailing Address - Phone:662-470-6845
Mailing Address - Fax:662-874-5190
Practice Address - Street 1:5740 GETWELL RD STE B
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672
Practice Address - Country:US
Practice Address - Phone:662-470-6845
Practice Address - Fax:662-874-5190
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000007251363LW0102X
MS901468363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health