Provider Demographics
NPI:1720702376
Name:DOZIER, NAKITA (FNP-C)
Entity Type:Individual
Prefix:
First Name:NAKITA
Middle Name:
Last Name:DOZIER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 NOTTING HILL PL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-8024
Mailing Address - Country:US
Mailing Address - Phone:601-287-0842
Mailing Address - Fax:
Practice Address - Street 1:SGH MEDICAL CLINIC
Practice Address - Street 2:1827C SIMPSON HWY 149
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114
Practice Address - Country:US
Practice Address - Phone:601-847-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904924363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS800776328OtherDRIVER LICENSE