Provider Demographics
NPI:1619275237
Name:FAULKNER-CRAIG, TAMMY F (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:F
Last Name:FAULKNER-CRAIG
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-3214
Mailing Address - Country:US
Mailing Address - Phone:601-398-7248
Mailing Address - Fax:
Practice Address - Street 1:1201 HIGHWAY 49 S
Practice Address - Street 2:SUITE 4
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-9425
Practice Address - Country:US
Practice Address - Phone:601-932-6400
Practice Address - Fax:601-932-6437
Is Sole Proprietor?:No
Enumeration Date:2011-03-06
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
78148 OR 78149OtherUNITED HEALTHCARE
MS08287715Medicaid
MS30250I9079Medicare PIN