Provider Demographics
NPI:1154935104
Name:HARPER, MIRANDA RAWLS (DNP, FNP)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:RAWLS
Last Name:HARPER
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-2312
Mailing Address - Country:US
Mailing Address - Phone:662-716-8071
Mailing Address - Fax:662-716-8072
Practice Address - Street 1:2121 GRAND AVE
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2312
Practice Address - Country:US
Practice Address - Phone:662-716-8071
Practice Address - Fax:662-716-8072
Is Sole Proprietor?:No
Enumeration Date:2020-09-06
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily