Provider Demographics
NPI:1265534648
Name:HEDGEPETH, MARLANA PERKINS (FNP)
Entity type:Individual
Prefix:
First Name:MARLANA
Middle Name:PERKINS
Last Name:HEDGEPETH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARLANA
Other - Middle Name:E
Other - Last Name:HEDGEPETH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-0177
Mailing Address - Country:US
Mailing Address - Phone:601-477-2221
Mailing Address - Fax:601-477-2223
Practice Address - Street 1:80 HAL CROCKER RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-2089
Practice Address - Country:US
Practice Address - Phone:601-477-2221
Practice Address - Fax:601-477-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR755324363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS640507572YVOtherAMERICAN ADMIN GROUP
MS00124941Medicaid
LA1783269Medicaid
P00346938OtherRAILROAD MEDICARE
P00346938OtherRAILROAD MEDICARE
P44370Medicare UPIN