Provider Demographics
NPI:1699773820
Name:VISCONTI, JOSEPH ANTHONY (FNP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:VISCONTI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PHYSICIANS LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6102
Mailing Address - Country:US
Mailing Address - Phone:662-393-7722
Mailing Address - Fax:662-280-6239
Practice Address - Street 1:75 PHYSICIANS LN
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6102
Practice Address - Country:US
Practice Address - Phone:662-393-7722
Practice Address - Fax:662-280-6239
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS810034363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily