Provider Demographics
NPI:1821278813
Name:WARD, MARY ANN (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:WARD
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 1:1600 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3223
Mailing Address - Country:US
Mailing Address - Phone:601-483-5322
Mailing Address - Fax:601-693-8081
Practice Address - Street 1:2113 11TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-5149
Practice Address - Country:US
Practice Address - Phone:601-483-5322
Practice Address - Fax:601-693-8081
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR856368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily