Provider Demographics
NPI:1649689548
Name:PRIDGEN, DAYNA HAMM (FNP)
Entity type:Individual
Prefix:
First Name:DAYNA
Middle Name:HAMM
Last Name:PRIDGEN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:DAYNA
Other - Middle Name:MICHELLE
Other - Last Name:HAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39168-0291
Mailing Address - Country:US
Mailing Address - Phone:601-705-2897
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:1050 SW 6TH AVE STE 1100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1153
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS881108363LF0000X
LARN125240163W00000X
MSR881108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01839212Medicaid