Individual
MRS. CHARLOTTE PEAVIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
5879 MADISON EDWARD DR, JACKSON, MS 39206
(601) 984-5475
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5475
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R583529
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00111411
—
MS
01
—
302I507758
MEDICARE PTAN
MS
Enumeration date
10/03/2006
Last updated
06/26/2017
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