| NPI | 1679554190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA JACKSON Administrator 662-293-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2020-08-22 |