Individual
PHYLLIS FIVEASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
2001 STATE DR, CORINTH, MS 38834-9324
(662) 286-3694
(901) 685-9718
Mailing address
401 ALCORN DR, STE 2C, CORINTH, MS 38834-9073
(901) 683-0055
(901) 685-9718
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R871915
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05170544
—
MS
Enumeration date
02/23/2010
Last updated
05/15/2018
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