Individual
MARY GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
613 MARQUETTE RD, BRANDON, MS 39042-3038
(601) 824-0342
Mailing address
PO BOX 88, BRANDON, MS 39043-0088
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
903623
MS
Other
Enumeration date
11/22/2019
Last updated
11/22/2019
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