Provider Demographics
NPI:1215903794
Name:FRETZ, ANN (NP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:FRETZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 EMERGENCY DR
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-9357
Mailing Address - Country:US
Mailing Address - Phone:662-494-1870
Mailing Address - Fax:662-494-0002
Practice Address - Street 1:850 EMERGENCY DR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-9357
Practice Address - Country:US
Practice Address - Phone:662-494-1870
Practice Address - Fax:662-494-0002
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR670545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118203Medicaid
MS500000225Medicare PIN
MSS39821Medicare UPIN