Provider Demographics
NPI:1568200673
Name:POPE, SANDRA LINDSEY (SRNA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LINDSEY
Last Name:POPE
Suffix:
Gender:F
Credentials:SRNA
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LINDSEY
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:1130 WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-2504
Mailing Address - Country:US
Mailing Address - Phone:601-616-8079
Mailing Address - Fax:601-616-8079
Practice Address - Street 1:2124 14TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4040
Practice Address - Country:US
Practice Address - Phone:601-553-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty