Provider Demographics
NPI:1013283829
Name:NORMAN, VANESSA (AGPCNP)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP
Mailing Address - Street 1:2800 NORTH HILLS STREET
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305
Mailing Address - Country:US
Mailing Address - Phone:601-693-9906
Mailing Address - Fax:601-703-4597
Practice Address - Street 1:252 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345
Practice Address - Country:US
Practice Address - Phone:601-683-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850781363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology