Individual
DR. BLAKE MYLES MERANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, FNP
Contact information
Practice address
1706 W 10TH ST, LAUREL, MS 39440-2557
(601) 682-0455
(601) 682-0456
Mailing address
303 N 20TH AVE, HATTIESBURG, MS 39401-4750
(228) 493-2562
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
906558
MS
Other
Enumeration date
02/29/2024
Last updated
02/29/2024
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