Individual
MOLLIE HARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 N STATE ST, PFS, JACKSON, MS 39216-4500
(601) 984-4619
Mailing address
2500 N STATE ST, PFS, JACKSON, MS 39216-4500
(601) 984-4619
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R688673
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00123249
MS MEDICAID
MS
Enumeration date
10/05/2006
Last updated
12/13/2010
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