Individual
MRS. EDITH MOODY FAULKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1205 HIGHWAY 182 W STE B, STARKVILLE, MS 39759-9820
(662) 377-5199
(662) 377-2264
Mailing address
808 VARSITY DR, TUPELO, MS 38801-4613
(662) 377-3204
(662) 377-2057
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R865568
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008880771
—
MS
Enumeration date
03/06/2013
Last updated
03/12/2024
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