Provider Demographics
NPI:1851846810
Name:WARREN, JOANNA (CPNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 22ND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4016
Mailing Address - Country:US
Mailing Address - Phone:601-703-8370
Mailing Address - Fax:601-703-8390
Practice Address - Street 1:1523 22ND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4016
Practice Address - Country:US
Practice Address - Phone:601-703-8370
Practice Address - Fax:601-703-8390
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS874207163W00000X
MS901770363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse