Provider Demographics
NPI:1629517115
Name:EDGAR, DELANA (FNP)
Entity Type:Individual
Prefix:
First Name:DELANA
Middle Name:
Last Name:EDGAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DELANA
Other - Middle Name:
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-296-2833
Mailing Address - Fax:
Practice Address - Street 1:6414 HIGHWAY 98
Practice Address - Street 2:SUITE 120
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-296-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily