Provider Demographics
NPI:1871841080
Name:WILLIFORD, NANCY J (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:J
Last Name:WILLIFORD
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9212
Mailing Address - Country:US
Mailing Address - Phone:601-420-2353
Mailing Address - Fax:601-420-2352
Practice Address - Street 1:4213 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9212
Practice Address - Country:US
Practice Address - Phone:601-420-2353
Practice Address - Fax:601-420-2352
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00783551Medicaid