Provider Demographics
NPI:1730488040
Name:SPINKS, DELORES LANEHART (FNPC)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:LANEHART
Last Name:SPINKS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:DELORES
Other - Last Name:SPINKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNPC
Mailing Address - Street 1:402 LEVEE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:LA
Mailing Address - Zip Code:71366-6661
Mailing Address - Country:US
Mailing Address - Phone:601-446-5353
Mailing Address - Fax:
Practice Address - Street 1:204 TRACESIDE DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-9278
Practice Address - Country:US
Practice Address - Phone:601-446-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR633941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily