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Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Obstetrics & Gynecology

Provider NPI: 1962582585

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
1401 OAK ST  GRENADA, MS 38901-4633 US
Tel: 662-226-4010  Fax: 662-226-4495

Business Mailing Address:
1401 OAK ST  GRENADA, MS 38901-4633 US
Tel: 662-226-4010  Fax: 662-226-4495

NPI Information:
NPI: 1962582585
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N363LX0001XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Obstetrics & Gynecology
Y367A00000XPhysician Assistants & Advanced Practice Nursing Providers
Midwife, Certified Nurse

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 367A00000X





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