PROVIDENCE HEALTH, PLLC

SOUTHAVEN, MS
NPI1134795628
Entity TypeOrganization
Authorized ContactIRENE WILSON
Fnp C
901-486-0439
Organization Subpart ?No
Primary Taxonomy363L00000X Nurse Practitioner
Enumeration Date2021-06-03
Last Update Date2021-06-03
Business Address
PROVIDENCE HEALTH, PLLC
7075 GOLDEN OAKS LOOP W STE 10
SOUTHAVEN, MS 38671-9012
Phone number: 901-486-0439
Mailing Address
PROVIDENCE HEALTH, PLLC
481 CLARINGTON DR
SOUTHAVEN, MS 38671-5638
Phone number: 901-486-0439
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