Individual
LESLIE TYNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP, RNFA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5500
(601) 984-5503
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5500
(601) 984-5503
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
903191
MS
363L00000X
Nurse Practitioner
903191
MS
363LA2100X
Acute Care Nurse Practitioner
1-111893
AL
363LA2100X
Acute Care Nurse Practitioner
Primary
903191
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01574210
—
MS
Enumeration date
05/04/2017
Last updated
08/06/2020
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