Provider Demographics
NPI:1871944652
Name:HARVEY, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 DUNBARTON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5001
Mailing Address - Country:US
Mailing Address - Phone:601-982-5376
Mailing Address - Fax:601-824-0349
Practice Address - Street 1:1920 DUNBARTON DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5001
Practice Address - Country:US
Practice Address - Phone:601-982-5376
Practice Address - Fax:601-982-5377
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901591363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03355270Medicaid
MS09878076Medicaid