Individual
HANNA DEGROAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5606 OLD CANTON RD, JACKSON, MS 39211-4217
(601) 957-3333
Mailing address
308 CORPORATE DR, RIDGELAND, MS 39157-8803
(601) 898-7530
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901995
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
901995
STATE
MS
Enumeration date
04/03/2017
Last updated
04/24/2017
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