Provider Demographics
NPI:1629371653
Name:BRAGG, ELIZABETH P (CFNPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:P
Last Name:BRAGG
Suffix:
Gender:F
Credentials:CFNPC
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:I
Other - Last Name:PURVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1
Mailing Address - Street 2:3550 HIGHWAY 468 WEST
Mailing Address - City:WHITFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39193-0157
Mailing Address - Country:US
Mailing Address - Phone:601-351-8000
Mailing Address - Fax:601-351-8586
Practice Address - Street 1:3550 HIGHWAY 468 WEST
Practice Address - Street 2:
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193-0157
Practice Address - Country:US
Practice Address - Phone:601-351-8000
Practice Address - Fax:601-351-8586
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily