| NPI | 1912032830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORIS MITCHELL Director 662-846-6306 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MS R125740) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |