Individual
LOLITA DENISE HARTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1828 HOSPITAL DR, JACKSON, MS 39204-3410
(601) 487-8594
(601) 487-8570
Mailing address
1445 CHERRY GROVE RD, CRYSTAL SPRINGS, MS 39059-8749
(601) 316-1474
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
902992
MS
Other
Enumeration date
03/18/2019
Last updated
10/21/2020
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