Provider Demographics
NPI:1639352123
Name:BUIE, JOYCE DELORIS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:DELORIS
Last Name:BUIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3062 LONGFELLOW RD
Mailing Address - Street 2:#25
Mailing Address - City:BAY ST. LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520
Mailing Address - Country:US
Mailing Address - Phone:228-467-4510
Mailing Address - Fax:228-466-6227
Practice Address - Street 1:3062 LONGFELLOW RD
Practice Address - Street 2:#25
Practice Address - City:BAY ST. LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520
Practice Address - Country:US
Practice Address - Phone:228-467-4510
Practice Address - Fax:228-466-6227
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP01225363LF0000X
MSR862697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1995525Medicaid
LAAP01225OtherLA STATE LICENSE