Individual
BRANDI LATRECE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
824B N GLOSTER ST, TUPELO, MS 38804-1949
(662) 222-1911
Mailing address
824B N GLOSTER ST, TUPELO, MS 38804-1949
(662) 222-1911
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
904681
MS
Other
Enumeration date
09/03/2021
Last updated
09/03/2021
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