Provider Demographics
NPI:1285176271
Name:MAYFIELD, AIMEE (NP)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:
Last Name:MAYFIELD
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 1:801 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3956
Mailing Address - Country:US
Mailing Address - Phone:601-798-5558
Mailing Address - Fax:
Practice Address - Street 1:801 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3956
Practice Address - Country:US
Practice Address - Phone:601-798-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS586835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily