Provider Demographics
NPI:1831780857
Name:MUNN, PAUL THOMAS (NP-C)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:MUNN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-6018
Mailing Address - Country:US
Mailing Address - Phone:601-382-1647
Mailing Address - Fax:
Practice Address - Street 1:1827C SIMPSON HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-3439
Practice Address - Country:US
Practice Address - Phone:601-847-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903483363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner