Provider Demographics
NPI:1154355428
Name:ATKINSON, MICHELLE S (DNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:S
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:1930 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-8220
Mailing Address - Country:US
Mailing Address - Phone:601-267-8368
Mailing Address - Fax:601-267-6639
Practice Address - Street 1:1930 N PEARL ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-8220
Practice Address - Country:US
Practice Address - Phone:601-267-8368
Practice Address - Fax:601-267-6639
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853540363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121839Medicaid
MS0121839Medicaid
TX8ED342Medicare PIN
TX8ED340Medicare PIN
TX8EC743Medicare PIN
MSR853540OtherSTATE NP LICENSE
TX8ED341Medicare PIN