Provider Demographics
NPI:1710906268
Name:DEVELIN, DEBRA MIMS (CRNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MIMS
Last Name:DEVELIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SIMPSON HIGHWAY 149 STE 310
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3849
Mailing Address - Country:US
Mailing Address - Phone:601-849-1220
Mailing Address - Fax:601-849-5832
Practice Address - Street 1:360 SIMPSON HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111
Practice Address - Country:US
Practice Address - Phone:601-849-1220
Practice Address - Fax:601-849-5832
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR633283363LF0000X
AL1-093189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03235798Medicaid
MS03235798Medicaid