Facts
- Status
- A
- Credential
- RNC,OGNP
- Type
- Individual
- Enumeration date
- 2007-02-13
- Last updated
- 2010-06-21
Specialties
Licenses
- License MS
- R513474
Location
- Practice location
- MILL ROAD
- City
- BUDE MS
- Postal code
- 39630
- Phone
- 601-384-5871
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.