| NPI | 1982115945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDELL T CARNEY Fnp 601-513-8508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS 862287) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2023-01-18 |