| NPI | 1356693287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARITA GLOVER JACKSON Owner 662-316-1334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R856333) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2012-10-02 |