Provider Demographics
NPI:1538220793
Name:GRIFFIN, LENORA (CFNP)
Entity type:Individual
Prefix:
First Name:LENORA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:MS
Mailing Address - Zip Code:38879-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1423 PALMETTO RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:MS
Practice Address - Zip Code:38879
Practice Address - Country:US
Practice Address - Phone:662-566-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR112510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118580Medicaid
MS0118580Medicaid
500001051Medicare ID - Type Unspecified