| NPI | 1013525187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALARIE KERSHAW-BERRY Over/Nurse Practitioner 662-902-9883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2025-05-13 |