Individual
TANYA UNDERWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1041 S MADISON ST, TUPELO, MS 38801-6309
(662) 844-8754
Mailing address
1109 WALNUT ST, AMORY, MS 38821-3715
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
865557
MS
363LW0102X
Women's Health Nurse Practitioner
Primary
905071
MS
Other
Enumeration date
04/17/2020
Last updated
01/24/2022
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