| NPI | 1952323073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANITA S. PRATT Clinic Administrator 662-286-0088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 11767) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MS 18218) |
| 363LF0000X Nurse Practitioner Family (Licence: MS R865946) | |
| 363LF0000X Nurse Practitioner Family (Licence: MS R865725) | |
| 363LF0000X Nurse Practitioner Family (Licence: MS R649279) | |
| 363LF0000X Nurse Practitioner Family (Licence: MS R582662) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2015-01-23 |