Provider Demographics
NPI:1316942790
Name:LUNSFORD, NOEL ANTHONY (NP)
Entity type:Individual
Prefix:MR
First Name:NOEL
Middle Name:ANTHONY
Last Name:LUNSFORD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2654
Mailing Address - Country:US
Mailing Address - Phone:601-823-1710
Mailing Address - Fax:601-825-8130
Practice Address - Street 1:290 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2654
Practice Address - Country:US
Practice Address - Phone:601-823-1710
Practice Address - Fax:601-825-8130
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA116795363L00000X
MSR878488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07106761Medicaid
IA1316942790Medicaid
IA1316942790Medicaid
INQ55077Medicare UPIN