Provider Demographics
NPI:1770625048
Name:MARTIN, JOYCE BRENDA (CFNP)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:BRENDA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:
Other - Last Name:TALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:154 PERES RD
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-8527
Mailing Address - Country:US
Mailing Address - Phone:601-799-5604
Mailing Address - Fax:
Practice Address - Street 1:400S CHESTNUT ST
Practice Address - Street 2:PIONEER COMMUNITY HOSPITAL
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-8527
Practice Address - Country:US
Practice Address - Phone:601-799-5604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR787118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSQ38671Medicare UPIN
MS500001737Medicare ID - Type Unspecified