WANDA JANE DEDEAUX FNP NPI 1639171234

NPI Information

NPI: 1639171234
Provider Name: WANDA JANE DEDEAUX, FNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
1820 OLD MOBILE AVE
PASCAGOULA, MS
ZIP 39567
Phone: (228) 696-0230
Get Directions

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
1	363LF0000X	Nurse Practitioner	Family	R744414	MISSISSIPPI	Yes

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
1	00120206	MEDICAID	MISSISSIPPI
2	500000408	MEDICARE ID-TYPE UNSPECIFIED	MISSISSIPPI
3	S69488	MEDICARE UPIN	MISSISSIPPI

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: 5/5/2024

NPI Synchronization or Removal

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