Provider Demographics
NPI:1679624696
Name:MAYFIELD, DIANN BRANTON (CNP)
Entity type:Individual
Prefix:
First Name:DIANN
Middle Name:BRANTON
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DIANN
Other - Middle Name:BRANTON
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APMH-NP
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-579-5463
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:2 SOUTHERN POINT PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8025
Practice Address - Country:US
Practice Address - Phone:601-261-5159
Practice Address - Fax:601-268-2039
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR573957363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health