Organization · Type 2 NPI

Medical Mall Health Services of Mississippi, LLC

Primary Care Nurse Practitioner · Jackson, MS

NPI number 1194083139 Active

Practice location

350 W Woodrow Wilson Ave, Suite 499A
Jackson, MS 39213-7681

Fax (877) 852-6352

Mailing address

350 W Woodrow Wilson Ave., Suite 499A
Jackson, MS 39213-7681

Specialties and licenses

TaxonomyCodeLicense
Primary Care Nurse Practitioner Primary 363LP2300XNone listed

Primary Care Nurse Practitioner: Definition to come...

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About NPI 1194083139

Medical Mall Health Services of Mississippi, LLC's National Provider Identifier is 1194083139, issued on Apr 27, 2012. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Jackson, MS. The record was last updated on Mar 12, 2015.