| NPI | 1184166035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACK E KNIGHT Owner 601-408-9945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MS 732001) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 732001) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 901749) | |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2017-10-19 |