Provider Demographics
NPI:1972579050
Name:GLENN, FRANCINE (NP)
Entity Type:Individual
Prefix:
First Name:FRANCINE
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DUTCH LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5500
Mailing Address - Country:US
Mailing Address - Phone:662-329-3808
Mailing Address - Fax:662-329-3873
Practice Address - Street 1:450 E PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5599
Practice Address - Country:US
Practice Address - Phone:662-377-3204
Practice Address - Fax:662-377-2755
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR65321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122327Medicaid
MSP42998Medicare UPIN
MS00122327Medicaid