Provider Demographics
NPI:1205589157
Name:SISSON, ALLYN CHESNEY (FNP)
Entity type:Individual
Prefix:
First Name:ALLYN
Middle Name:CHESNEY
Last Name:SISSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALLYN
Other - Middle Name:LOUISE
Other - Last Name:CHESNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4909 GREAT RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305
Mailing Address - Country:US
Mailing Address - Phone:601-282-8980
Mailing Address - Fax:601-693-6561
Practice Address - Street 1:4909 GREAT RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305
Practice Address - Country:US
Practice Address - Phone:601-282-8980
Practice Address - Fax:601-693-6561
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily