Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Manivanh A Prudhomme, MSN, FNP-BC, AGACNP

Individual provider Family Nurse Practitioner · NPI 1144831140

Manivanh A Prudhomme, MSN, FNP-BC, AGACNP is a Nurse Practitioner in Vicksburg, Mississippi. Qualified in 2020, 6 years ago. Practices with Quad Intermed Company LLC, a 42-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
6
Licensed in
MS
In the registry since
2020
What do these letters mean?
MSN — Master of Science in Nursing
A graduate nursing degree, usually held alongside an advanced practice licence.
FNP-BC — Family Nurse Practitioner, Board Certified
A family nurse practitioner certified by the ANCC.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

2011 Highway 61 N
Vicksburg, MS 39183-3918
Phone: (014) 562-2776
Fax: (601) 456-2622
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 904068 (MS)

Record details

NPI number1144831140
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSN , FNP-BC , AGACNP
Sole proprietorNo
NPI enumeratedAugust 12, 2020
Last updated in NPPESJuly 13, 2021
Certification dateJuly 13, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Quad Intermed Company Llc — 42 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Vicksburg