Provider Demographics
NPI:1154572857
Name:DEAN, MARY SHAREE (ACNP-BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SHAREE
Last Name:DEAN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S THOMAS ST STE 202
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5337
Mailing Address - Country:US
Mailing Address - Phone:662-269-4453
Mailing Address - Fax:662-583-4018
Practice Address - Street 1:144 S THOMAS ST STE 202
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-5337
Practice Address - Country:US
Practice Address - Phone:662-269-4453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR803122363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1518237932OtherGROUP NPI
MS00622390Medicaid
MS1154572857OtherINDIVIDUAL NPI
MSR803122OtherBOARD OF NURSING
MSR803122OtherBOARD OF NURSING
MS1518237932OtherGROUP NPI