| NPI | 1184861320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M BYRD Owner 601-941-5497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MS R652075) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MS R652075) |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2009-01-09 |