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Individual

MRS. MICHELE BRYANT MAHAFFEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
1014 ROSE ST, SUITE A, PRENTISS, MS 39474-5271
(601) 792-2200
(601) 792-2345
Mailing address
PO BOX 667, 1014 ROSE STREET SUITE A, PRENTISS, MS 39474-0667
(601) 792-2200
(601) 792-2345

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R667552
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05851817
MS
01
12117492
CAQH
MS
Enumeration date
07/20/2006
Last updated
06/28/2016
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