Individual
BRENDA L STALLION-PATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1190 N STATE STREET, JACKSON, MS 39202
(601) 292-4292
Mailing address
1190 N STATE ST, JACKSON, MS 39202-2413
(601) 929-4292
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
94221
MS
Other
Enumeration date
11/12/2020
Last updated
01/27/2021
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