Individual
TYRONE LEAVETTE RUPERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
824 ALABAMA ST, COLUMBUS, MS 39702-5436
(662) 244-0391
Mailing address
3119 SIERRA CT, COLUMBUS, MS 39705-1807
(662) 889-3246
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R867788
MS
Other
Enumeration date
11/16/2009
Last updated
11/16/2009
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