Individual
TIFFANY SOPHIA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
304 S PARKWAY ST, CORINTH, MS 38834-5913
(662) 642-1560
(662) 200-5994
Mailing address
304 S PARKWAY ST, CORINTH, MS 38834-5913
(626) 642-1560
(662) 200-5994
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903343
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900162
MEDICARE
MS
05
—
PENDING
—
MS
05
—
Q054688
—
TN
01
—
T12267A
MEDICARE
TN
Enumeration date
05/20/2019
Last updated
01/31/2024
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