Individual
MRS. VICKI NICOLE LARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
103 BASKET ST, ITTA BENA, MS 38941-2801
(662) 254-7801
(662) 254-9173
Mailing address
2207 RIVER ROAD EXTENDED, GREENWOOD, MS 38930
(662) 451-9984
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R860262
MS
Other
Enumeration date
11/17/2006
Last updated
03/30/2009
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