Basic Information
| Provider Information | |||||||||
| NPI: | 1720702376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOZIER | ||||||||
| FirstName: | NAKITA | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 159 NOTTING HILL PL | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390468024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012870842 | ||||||||
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| Practice Location | |||||||||
| Address1: | SGH MEDICAL CLINIC | ||||||||
| Address2: | 1827C SIMPSON HWY 149 | ||||||||
| City: | MENDENHALL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018472424 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2022 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC1500X | 904924 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health |
ID Information
| ID | Type | State | Issuer | Description | 800776328 | 01 | MS | DRIVER LICENSE | OTHER |