Individual
KENEISHA DEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1668 W PEACE ST, CANTON, MS 39046-5332
(662) 859-5213
Mailing address
416 FOREST LN, RIDGELAND, MS 39157-4134
(662) 299-9517
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
903945
MS
Other
Enumeration date
07/27/2020
Last updated
07/27/2020
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