Provider Demographics
NPI:1730196353
Name:WARREN, JOANNA MCGOWAN (RN, MSN, CFNP)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MCGOWAN
Last Name:WARREN
Suffix:
Gender:F
Credentials:RN, MSN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 LAKELAND DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4643
Mailing Address - Country:US
Mailing Address - Phone:601-948-5158
Mailing Address - Fax:
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:SUITE 450
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-948-5158
Practice Address - Fax:601-949-6058
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865985363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSF0606255OtherCERTIFICATION #
MSR865985OtherLICENSURE #