Individual
SUSAN D BOBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1818 COLLEGE DRIVE, MERIDIAN, MS 39307-5429
(601) 581-8482
(601) 483-5543
Mailing address
PO BOX 4128, MERIDIAN, MS 39304-4128
(601) 581-8482
(601) 483-5543
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R802552
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07526012
—
MS
Enumeration date
09/20/2006
Last updated
12/13/2013
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