Individual
DEALICE NIKITA YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
160 CYPRESS ST, TCHULA, MS 39169
(662) 670-4197
Mailing address
PO BOX 572, TCHULA, MS 39169-0572
(662) 670-4197
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
894906
MS
Other
Enumeration date
12/05/2011
Last updated
10/23/2017
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