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1700437076
FRED ALLEN RAYBURN
TUPELO, MS
NPI
1700437076
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: MS 903556)
Enumeration Date
2019-09-26
Last Update Date
2019-09-26
Business Address
FRED ALLEN RAYBURN FNP - BC
848 S MADISON ST
TUPELO, MS 38801-4905
Phone number: 662-844-4177
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Mailing Address
FRED ALLEN RAYBURN FNP - BC
4611 TOXISH RD
PONTOTOC, MS 38863-7080
Phone number: 662-488-5658
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