| NPI | 1902311723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEANDRIA F EVANS Administator 662-380-1978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 17048) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2017-12-04 |