Individual
MYCHELL THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
199 CHARMANT PLACE, RIDGELAND, MS 39157
(601) 790-9175
Mailing address
199 CHARMANT PLACE, RIDGELAND, MS 39157
(601) 790-9175
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P330299
MS
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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