| NPI | 1417620071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANIVANH A PRUDHOMME CEO 601-456-2277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2023-01-17 |