Individual
MISS MONTOYAE C LEAVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
747 INDUSTRIAL PARK RD NE, BROOKHAVEN, MS 39601-2065
(601) 833-4111
Mailing address
122A RICHMOND TRL NE, BROOKHAVEN, MS 39601-4077
(601) 400-1375
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
902224
MS
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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