Individual
RICKY BERNARD CONWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
REGISTERED NURSE
Contact information
Practice address
5732 ANGLE DRIVE, JACKSON, MS 39206-3920
(601) 832-0616
Mailing address
5732 ANGLE DRIVE, JACKSON, MS 39206
(601) 832-0616
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
860326
MS
Other
Enumeration date
04/08/2020
Last updated
04/08/2020
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