Individual
DEBORAH LATRICE PRIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4365 HIGHWAY 51 S, SENATOBIA, MS 38668-2533
(662) 562-3049
(877) 855-7540
Mailing address
4365 HIGHWAY 51 S, SENATOBIA, MS 38668-2533
(662) 562-3049
(877) 855-7540
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
800280913
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8859
—
MS
Enumeration date
05/03/2018
Last updated
05/03/2018
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