is a Family in Clarksdale, Mississippi. practices all healthcare services and medical treatments related to Family. The NPI Number for is 1376752832. The last update date is .
's current location address is 1015 Lee Dr Ste 13, Clarksdale, Mississippi. You can contact this provider via phone number 6625924170 and fax number 6622690226. The mailing address for is 1015 Lee Dr Ste 13, Clarksdale, Mississippi. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 1015 Lee Dr Ste 13, Clarksdale, Mississippi |
| Phone Number | 6625924170 |
| Fax Number | 6622690226 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1376752832 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 1015 Lee Dr Ste 13 |
|---|---|
| City | Clarksdale |
| State | Mississippi (MS) |
| Post Code | 386143619 |
| Phone Number | 6625924170 |
| Fax Number | 6622690226 |
Provider's Primary Taxonomy Detail
| Speciality | Family |
|---|---|
| Taxonomy | 363Lf0000X |
| Licence No | 12310 |
|
Definition: An advanced practice registered nurse expert in primary healthcare for patients of all ages. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 9128041 | MS | -- |
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