Provider Demographics
NPI:1700125002
Name:ANTICI, VALERIE ORCUTT (FNP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ORCUTT
Last Name:ANTICI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:ELMA
Other - Last Name:ORCUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:785 OHIO AVE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6217
Mailing Address - Country:US
Mailing Address - Phone:662-624-5464
Mailing Address - Fax:
Practice Address - Street 1:785 OHIO AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6217
Practice Address - Country:US
Practice Address - Phone:662-624-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR878089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily