Provider Demographics
NPI:1447208830
Name:HARRISON, LYNDA DENISE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:DENISE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BELLEGRASS BLVD.
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402
Mailing Address - Country:US
Mailing Address - Phone:601-620-0370
Mailing Address - Fax:602-620-0369
Practice Address - Street 1:16 BELLEGRASS BLVD.
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-620-0370
Practice Address - Fax:602-620-0369
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR764142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119353Medicaid
MS00119353Medicaid
S54760Medicare UPIN