Individual
MYRANDA ARCHIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5604 OLD CANTON RD, JACKSON, MS 39211-4217
(601) 991-1044
Mailing address
5604 OLD CANTON RD, JACKSON, MS 39211-4217
(601) 991-1044
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
906731
MS
Other
Enumeration date
06/19/2024
Last updated
06/19/2024
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