| NPI | 1508263179 |
|---|---|
| Doing Business As | ST. DOMINIC FAMILY PRACTICE ASSOCIATES-JACKSON |
| Entity Type | Organization |
| Authorized Contact | DANIELLE STUART Credentialing Representative 2 601-200-4880 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R886071) |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2021-10-18 |