Provider Demographics
NPI:1578658225
Name:TOLLESON, BARBARA ANN (CFNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:TOLLESON
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:PO BOX 24146
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-4146
Mailing Address - Country:US
Mailing Address - Phone:601-984-4084
Mailing Address - Fax:601-984-2383
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-4084
Practice Address - Fax:601-984-2383
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR819026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00650871OtherRAILROAD MEDICARE
MS07783218Medicaid
MS500002292Medicare PIN
MSP00650871OtherRAILROAD MEDICARE
MS302I505617Medicare PIN
MSQ74879Medicare UPIN