Individual
COLEMAN FARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5650
(601) 984-5658
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5650
(601) 984-5658
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R858106
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04608339
—
MS
Enumeration date
08/13/2013
Last updated
12/30/2014
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