| NPI | 1972857548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA COCKRELL Member 601-259-7345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R747936) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2014-02-27 |