Individual
AUSTIN HARBOR BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
5681 HIGHWAY 363, MANTACHIE, MS 38855-7632
(662) 282-4226
Mailing address
PO BOX 40, MANTACHIE, MS 38855-0040
(662) 282-4226
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
906272
MS
Other
Enumeration date
09/13/2023
Last updated
09/13/2023
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