Provider Demographics
NPI:1740552892
Name:ARMSTRONG, MARY PATTON (CNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PATTON
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:PATTON
Other - Last Name:LINTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-579-5463
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:502 BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3037
Practice Address - Country:US
Practice Address - Phone:601-736-8282
Practice Address - Fax:601-736-8333
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR883872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9972831OtherAETNA
MS08503773Medicaid
MS3424000OtherUNITED HEALTHCARE
MS4970336OtherCIGNA
MS4970336OtherCIGNA