| NPI | 1487792032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY MOORE Ins. Clerk 662-846-5032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R793654) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2010-03-09 |