Individual
MS. VICKY DIANNE MINNINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6525
(601) 984-6764
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6525
(601) 984-6764
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R638633
MS
363LF0000X
Family Nurse Practitioner
R638633
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0118842
—
MS
05
—
105774
—
AL
01
—
500005456
RAILROAD
MS
01
—
512G700003
UP MEDICARE
—
Enumeration date
05/28/2006
Last updated
08/10/2010
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