| NPI | 1003418997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE DIANE BOYD Owner 601-665-4429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-11-15 |
| Last Update Date | 2021-04-22 |