Evergreen Clini

NPI 1396763298 - Nurse Practitioner - 363LF0000X

NPI Details
NPI 1396763298
Enumeration Date 07/18/2006
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name JERRY JERRY
Position ADMINISTRATION
Phone (662) 963-9154
Fax (662) 963-9157
Practice Location
4929 HIGHWAY 371 S
NETTLETON MS, 38858-6901, US
Phone (662) 963-9154
Fax (662) 963-9157
Business Location
4929 HIGHWAY 371 S
NETTLETON MS, 38858-6901, US
Phone (662) 963-9154
Fax (662) 963-9157
Toxanomy
Taxonomy Code 363LF0000X
License State
License Number
Remove 1396763298 NPI Number
 

According to our database, Evergreen Clini NPI is 1396763298, taxonomy code is 363LF0000X Evergreen Clini physically located at 4929 Highway 371 S, Nettleton MS, 38858-6901. NPI Number 1033115704 has the healthcare provider type.

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1396763298 NPI number is provided on an as is basis without warranty of any kind. 1396763298 is maintained by the National Plan & Provider Enumeration System. The contents of Evergreen Clini are for informational purposes only.