Individual
DIANA MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2504 BROWNING ROAD 520, GREENWOOD, MS 38930-6022
(662) 453-6211
Mailing address
2504 BROWNING ROAD 520, GREENWOOD, MS 38930-6022
(662) 453-6211
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
R890200
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
906015
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
906015
PMHNP
MS
05
—
906015
—
MS
Enumeration date
03/29/2023
Last updated
07/11/2023
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