Provider Demographics
NPI:1861480485
Name:CENTENO, FAYE (WHCNP)
Entity Type:Individual
Prefix:MS
First Name:FAYE
Middle Name:
Last Name:CENTENO
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-1854
Mailing Address - Country:US
Mailing Address - Phone:228-300-7116
Mailing Address - Fax:
Practice Address - Street 1:1102 45TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2504
Practice Address - Country:US
Practice Address - Phone:228-863-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15659363LW0102X
MS902222363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health