Provider Demographics
NPI:1881436038
Name:HOUSTON, TIFFANY (FNP-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HOUSTON
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 1:35 LOOXAHOMA TYRO RD
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-6506
Mailing Address - Country:US
Mailing Address - Phone:662-560-7317
Mailing Address - Fax:
Practice Address - Street 1:35 LOOXAHOMA TYRO RD
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-6506
Practice Address - Country:US
Practice Address - Phone:662-560-7317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906705363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care