Provider Demographics
NPI:1952965642
Name:SKINNER, DAFINA J (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DAFINA
Middle Name:J
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WOODBURN WAY
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-8636
Mailing Address - Country:US
Mailing Address - Phone:601-212-0978
Mailing Address - Fax:
Practice Address - Street 1:104 WOODBURN WAY
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8636
Practice Address - Country:US
Practice Address - Phone:601-212-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily