Individual
ELLANIE L BESSONETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
303 MARION AVE, MCCOMB, MS 39648-2707
(601) 249-1350
(601) 249-1339
Mailing address
PO BOX 490, MCCOMB, MS 39649-0490
(601) 249-2701
(601) 249-2195
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R882864
MS
363LA2100X
Acute Care Nurse Practitioner
Primary
882864
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06079813
—
MS
Enumeration date
03/17/2015
Last updated
02/03/2017
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