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Individual

MARY KELLEY COUSINS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
290 LANEY LN, DEATSVILLE, AL 36022-4522
(334) 301-1296
Mailing address
290 LANEY LN, DEATSVILLE, AL 36022-4522
(334) 301-1296

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-096694
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
NA
NA
AL
Enumeration date
06/30/2019
Last updated
06/30/2019
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