Provider Demographics
NPI:1396030201
Name:SISSON, FALON RENE (FNP (AANP))
Entity type:Individual
Prefix:MS
First Name:FALON
Middle Name:RENE
Last Name:SISSON
Suffix:
Gender:F
Credentials:FNP (AANP)
Other - Prefix:
Other - First Name:FALON
Other - Middle Name:RENE
Other - Last Name:KUHAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-863-0500
Mailing Address - Fax:
Practice Address - Street 1:9454 THREE RIVERS RD
Practice Address - Street 2:SUITE D
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4294
Practice Address - Country:US
Practice Address - Phone:228-863-0500
Practice Address - Fax:228-863-0502
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR877243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily