Individual
LATERRA BROWN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1701 WHITE STREET, MCCOMB, MS 39648
(601) 684-2173
(601) 249-1062
Mailing address
1701 WHITE STREET, MCCOMB, MS 39648-2711
(601) 249-4235
(601) 249-4234
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
905000
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03722090
—
MS
01
—
2021028561
PMHNP CERTIFICATION
MS
Enumeration date
01/15/2022
Last updated
05/17/2023
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