Provider Demographics
NPI:1639614563
Name:ROBERTSON, FAYE ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:FAYE
Other - Middle Name:ANN
Other - Last Name:COLOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:326 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-4670
Mailing Address - Country:US
Mailing Address - Phone:662-251-5664
Mailing Address - Fax:
Practice Address - Street 1:326 MILITARY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-4670
Practice Address - Country:US
Practice Address - Phone:662-251-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901827405300000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No405300000XOther Service ProvidersPrevention Professional