Provider Demographics
NPI:1396436143
Name:GIVENS, TERA ELIZABETH (CNM)
Entity type:Individual
Prefix:MRS
First Name:TERA
Middle Name:ELIZABETH
Last Name:GIVENS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2830
Mailing Address - Country:US
Mailing Address - Phone:601-684-2300
Mailing Address - Fax:
Practice Address - Street 1:1318 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2830
Practice Address - Country:US
Practice Address - Phone:601-684-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS899584367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife