Individual
MRS. MICHELE FONTENELLE MCLEOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
967 CEDAR LAKE RD STE B, BILOXI, MS 39532-2128
(228) 396-8531
(228) 396-1835
Mailing address
1211 BEXLEY CHURCH RD, LUCEDALE, MS 39452-4643
(601) 947-7334
(228) 396-1835
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R645982
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05238388
—
MS
01
—
640617252002
TRICARE
MS
01
—
R645982
STATE LICENSE
MS
Enumeration date
07/21/2006
Last updated
03/07/2023
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