Individual
MRS. TARA B ENLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
204 INTERCHANGE DR, FULTON, MS 38843-6011
(662) 862-9040
(662) 409-2102
Mailing address
204 INTERCHANGE DR, FULTON, MS 38843-6011
(662) 862-9040
(662) 409-2102
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R860076
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04103589
—
MS
Enumeration date
03/23/2007
Last updated
09/14/2023
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