Provider Demographics
NPI:1720552755
Name:DEVAZIER, HANNAH WALDRIP (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:WALDRIP
Last Name:DEVAZIER
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:GRACE
Other - Last Name:WALDRIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2533
Mailing Address - Country:US
Mailing Address - Phone:662-563-6000
Mailing Address - Fax:662-563-2200
Practice Address - Street 1:107 EUREKA ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2533
Practice Address - Country:US
Practice Address - Phone:662-563-6000
Practice Address - Fax:662-563-2200
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904010163W00000X
MS904174363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE