Provider Demographics
NPI:1720841638
Name:NEVELS, MARY LOIS (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOIS
Last Name:NEVELS
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 SIMPSON HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-6001
Mailing Address - Country:US
Mailing Address - Phone:601-292-9350
Mailing Address - Fax:601-292-9351
Practice Address - Street 1:3661 SIMPSON HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-6001
Practice Address - Country:US
Practice Address - Phone:601-292-9350
Practice Address - Fax:601-292-9351
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF01241263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily