Provider Demographics
NPI:1942471115
Name:SHIVERS, JAMES HAROLD II (FNP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HAROLD
Last Name:SHIVERS
Suffix:II
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 GATES RD
Mailing Address - Street 2:
Mailing Address - City:BASSFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39421-9026
Mailing Address - Country:US
Mailing Address - Phone:601-765-3180
Mailing Address - Fax:601-765-2808
Practice Address - Street 1:701 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-3894
Practice Address - Country:US
Practice Address - Phone:601-765-3180
Practice Address - Fax:601-765-2808
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR813646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily