Provider Demographics
NPI:1467778423
Name:BYNUM, LEANNE TERRELL (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:TERRELL
Last Name:BYNUM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:LEANNE
Other - Middle Name:TERRELL
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-3700
Mailing Address - Fax:601-450-2493
Practice Address - Street 1:27 S SIXTH ST # A
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-9052
Practice Address - Country:US
Practice Address - Phone:601-764-2155
Practice Address - Fax:601-764-2150
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR793779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily