Basic Information
| Provider Information | |||||||||
| NPI: | 1992227177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUMMINGS | ||||||||
| FirstName: | CHARISMA | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | PCNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 RIVERVIEW DRIVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019811610 | ||||||||
| FaxNumber: | 6013662887 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 RIVERVIEW DRIVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019811610 | ||||||||
| FaxNumber: | 6013662887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 363LG0600X | 876889 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.