Provider Demographics
NPI:1386679579
Name:MCFALLS, DEBORA FIELDS (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:FIELDS
Last Name:MCFALLS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 COUNTY ROAD 255
Mailing Address - Street 2:
Mailing Address - City:GLEN
Mailing Address - State:MS
Mailing Address - Zip Code:38846-9227
Mailing Address - Country:US
Mailing Address - Phone:662-287-0301
Mailing Address - Fax:662-286-7010
Practice Address - Street 1:1801 S HARPER RD STE 7
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6726
Practice Address - Country:US
Practice Address - Phone:662-286-2300
Practice Address - Fax:662-286-7010
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR582662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121943Medicaid
MS00656871Medicaid
MS0121943Medicaid
MSP03978Medicare UPIN