Provider Demographics
NPI:1457419707
Name:TURNAGE, VICKI L (FNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:TURNAGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965
Mailing Address - Country:US
Mailing Address - Phone:662-473-1311
Mailing Address - Fax:662-473-4991
Practice Address - Street 1:604 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965
Practice Address - Country:US
Practice Address - Phone:662-473-1311
Practice Address - Fax:662-473-4991
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR728594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013597Medicaid
MSP03979Medicare PIN