| NPI | 1568230332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAWANA SHANTA LOCKWOOD Mental Health Nurse Practitioner 601-278-9688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-12-12 |
| Last Update Date | 2024-01-29 |