Individual
ERICIA LATRICE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITONER
Contact information
Practice address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
Mailing address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903107
MS
Other
Enumeration date
02/16/2019
Last updated
03/07/2019
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