Individual
SHAKITA DIANE RAWLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
155 HOSPITAL DR, TYLERTOWN, MS 39667-2021
(601) 876-5337
(601) 876-5190
Mailing address
155 HOSPITAL DR, TYLERTOWN, MS 39667-2021
(601) 876-5337
(601) 876-5190
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
892142
MS
363LF0000X
Family Nurse Practitioner
Primary
902365
MS
Other
Enumeration date
10/05/2017
Last updated
01/16/2025
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