Provider Demographics
NPI:1689791733
Name:ROWSEY, MISTY L (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:L
Last Name:ROWSEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PRATT DRIVE
Mailing Address - Street 2:SUITE 1 A
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834
Mailing Address - Country:US
Mailing Address - Phone:662-286-0088
Mailing Address - Fax:662-286-0067
Practice Address - Street 1:121 PRATT DRIVE
Practice Address - Street 2:SUITE 1 A
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834
Practice Address - Country:US
Practice Address - Phone:662-286-0088
Practice Address - Fax:662-286-0067
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05475099Medicaid