Individual
DALLAS MAXWELL EARNEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1015 LEE DR STE 13, CLARKSDALE, MS 38614-3619
(662) 592-4170
(662) 269-0226
Mailing address
1015 LEE DR STE 13, CLARKSDALE, MS 38614-3619
(662) 592-4170
(662) 269-0226
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
12310
TN
363LF0000X
Family Nurse Practitioner
Primary
R868182
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09128041
—
MS
Enumeration date
05/22/2007
Last updated
10/17/2024
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