Provider Demographics
NPI:1871674713
Name:DUFFIE, SUSAN (CFNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DUFFIE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:DUFFIE-MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:2434 S EASON BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-6942
Mailing Address - Country:US
Mailing Address - Phone:662-844-1717
Mailing Address - Fax:662-680-6416
Practice Address - Street 1:499 GLOSTER CREEK VLG
Practice Address - Street 2:SUITE A-3
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4600
Practice Address - Country:US
Practice Address - Phone:662-844-1717
Practice Address - Fax:662-680-6416
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR777236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0123240Medicaid
MSMD1222025OtherDEA NUMBER
MSP41510Medicare UPIN
MS346436YZ8ZMedicare PIN