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

Mrs. Misty Moore Ivy, CRNP

Individual provider Family Nurse Practitioner · NPI 1063465482

Mrs. Misty Moore Ivy, CRNP is a Nurse Practitioner in Olive Branch, Mississippi. Qualified in 2001, 25 years ago. Practices with Advanced Dermatology and Skin Cancer Associates, PLLC, a 12-clinician group and accepts Medicare assignment. Licensed in Mississippi and Tennessee.

Years since qualifying
25
Licensed in
MS, TN
In the registry since
2006
Specialties on file
2
What do these letters mean?
CRNP — Certified Registered Nurse Practitioner
The title Pennsylvania and some other states use for a nurse practitioner.

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Practice location Address checks out

7203 Goodman Rd
Olive Branch, MS 38654-1906
Phone: (901) 759-2322
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence R860233 (MS)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence APN11904 (TN)

Record details

NPI number1063465482
Entity typeIndividual (Type 1)
GenderFemale
Credentials CRNP
Sole proprietorNo
NPI enumeratedMay 18, 2006
Last updated in NPPESJune 20, 2024
Certification dateJune 20, 2024

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2001 (25 years in practice)
Group practice Advanced Dermatology And Skin Cancer Associates, Pllc — 12 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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