Individual
MRS. LATASHA JACKSON CLAIBORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
3444 WISCONSIN AVE, VICKSBURG, MS 39180-5331
(601) 638-0031
Mailing address
1701 WHITE ST, MCCOMB, MS 39648
(601) 249-4214
(601) 249-1062
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
163W00000X
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
904842
MS
Other
Enumeration date
08/03/2011
Last updated
03/17/2023
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