Individual
TIA ANTHONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
79 CLARK RD, CRAWFORD, MS 39743-9472
(662) 574-9799
Mailing address
79 CLARK RD, CRAWFORD, MS 39743-9472
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
906789
MS
Other
Enumeration date
08/23/2024
Last updated
08/23/2024
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