Provider Demographics
NPI:1588481733
Name:NASH, AVERY (NP)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:NASH
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 1:119 GREENS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8050
Mailing Address - Country:US
Mailing Address - Phone:601-421-1075
Mailing Address - Fax:
Practice Address - Street 1:101 LEXINGTON DR STE A
Practice Address - Street 2:
Practice Address - City:GLUCKSTADT
Practice Address - State:MS
Practice Address - Zip Code:39110-6986
Practice Address - Country:US
Practice Address - Phone:601-707-3771
Practice Address - Fax:601-707-3751
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily