WANDA JANE DEDEAUX FNP NPI 1639171234

NPI Information

  • NPI: 1639171234
  • Provider Name: WANDA JANE DEDEAUX, FNP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1820 OLD MOBILE AVE
    PASCAGOULA, MS
    ZIP 39567
  • Phone: (228) 696-0230

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NPI Details

Wanda Jane Dedeaux, FNP is a family nurse practitioner in Pascagoula, MS. Wanda Jane Dedeaux, FNP NPI is 1639171234. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1820 OLD MOBILE AVE
PASCAGOULA, MS
ZIP 39567-412
Phone: (228) 696-0230
Fax: (228) 712-2374

The NPI 1639171234 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/12/2005 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyR744414MISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100120206MEDICAIDMISSISSIPPI
2500000408MEDICARE ID-TYPE UNSPECIFIEDMISSISSIPPI
3S69488MEDICARE UPINMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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