Provider Demographics
NPI:1508193459
Name:SUMERFORD, DAVID BENSON (FNP-BC, PMHNP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BENSON
Last Name:SUMERFORD
Suffix:
Gender:M
Credentials:FNP-BC, PMHNP
Other - Prefix:MR
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:SUMERFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC, PMHNP-BC
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38870-0305
Mailing Address - Country:US
Mailing Address - Phone:662-690-8007
Mailing Address - Fax:662-651-4658
Practice Address - Street 1:499 GLOSTER CREEK VLG
Practice Address - Street 2:SUITE D-1
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4600
Practice Address - Country:US
Practice Address - Phone:662-690-8007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR884013363LF0000X
MS884013363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08725789Medicaid
MS08725789Medicaid