Individual
MARY GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
9140 HIGHWAY 51 N, SOUTHAVEN, MS 38671-1233
(662) 280-8222
(662) 280-5541
Mailing address
9140 HIGHWAY 51 N, SOUTHAVEN, MS 38671-1233
(662) 280-8222
(662) 280-5541
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R538515
MS
Other
Enumeration date
07/22/2008
Last updated
07/22/2008
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