Individual
KENDRA IESHA SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1434 CENTRAL AVE E, WIGGINS, MS 39577-9602
(601) 928-6600
Mailing address
1434 CENTRAL AVE E, WIGGINS, MS 39577-9602
(601) 928-6600
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902802
MS
Other
Enumeration date
08/27/2018
Last updated
10/22/2020
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