Individual
PHYLLIS GAIL KOONCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
100 COUNTY ROAD 714, BLUE MOUNTAIN, MS 38610-9743
(662) 538-4111
(662) 538-4128
Mailing address
100 COUNTY ROAD 714, BLUE MOUNTAIN, MS 38610-9743
(662) 538-4111
(662) 538-4128
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R125960
MS
Other
Enumeration date
08/10/2006
Last updated
07/08/2007
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