Individual
MS. PHYLLIS POLK JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 362-4471
(601) 368-4479
Mailing address
1542 FAIRWOOD DR, JACKSON, MS 39213-7915
(601) 366-2768
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R574848
MS
Other
Enumeration date
07/17/2006
Last updated
07/08/2007
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