Individual
KHANDRA ARIES IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
127 DRIVE 156, OKOLONA, MS 38860-9677
(662) 760-3031
Mailing address
127 DRIVE 156, OKOLONA, MS 38860-9677
(662) 760-3031
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
—
Other
Enumeration date
07/03/2023
Last updated
07/03/2023
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