Basic Information
| Provider Information | |||||||||
| NPI: | 1619275237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAULKNER-CRAIG | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 414 CLEVELAND ST | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390743214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013987248 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 HIGHWAY 49 S | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | RICHLAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392189425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019326400 | ||||||||
| FaxNumber: | 6019326437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2011 | ||||||||
| LastUpdateDate: | 01/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R870557 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 78148 OR 78149 | 01 | UNITED HEALTHCARE | OTHER | 08287715 | 05 | MS | MEDICAID |