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MARVELL SPEARS FNP

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1548365901

Individual Registrant:
 MARVELL  SPEARS FNP
Gender: M
Not Sole Proprietor

Location and contact information for practice:
2045 HIGHWAY 61 NORTH  PORT GIBSON, MS 39150-4262 US
Tel: 601-437-3050  Fax: 601-437-3051

Contact information for business:
PO BOX 741  PORT GIBSON, MS 39150-0741 US
Tel: 601-437-3050  Fax: 601-437-3051

Registration Information:
NPI: 1548365901
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
MSR703923

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
0119922MS05




HEALTH CARE JOBS MS - Page 1



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