Individual
KENDRIA SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2219 GREENWAY DR, JACKSON, MS 39204-3202
(601) 983-7494
Mailing address
2219 GREENWAY DR, JACKSON, MS 39204-3202
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902256
MS
Other
Enumeration date
07/06/2018
Last updated
07/06/2018
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