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Individual

JOHN CHRISTOPHER FUNKHOUSER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
N.P.

Contact information

Practice address
286 CALHOUN STATION PARKWAY, MADISON, MS 39110
(601) 200-4321
(601) 859-0159
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4749
(601) 200-5929

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R859048
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02300532
MS
01
P00739236
RAILROAD MEDICARE
Enumeration date
06/12/2007
Last updated
08/22/2019
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