Individual
TYRIKIA NICHOLLE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2803 OLD NORTH HILLS ST, MERIDIAN, MS 39305-1630
(601) 453-2919
Mailing address
860 E RIVER PL STE 100, JACKSON, MS 39202-3442
(769) 251-5550
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/09/2018
Last updated
10/09/2018
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