| NPI | 1902577174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARQUITA TUCKER Manager 601-909-8006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2021-10-04 |