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Individual

DESIREE STATES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CSS

Contact information

Practice address
407 BRIARWOOD DR STE 209, JACKSON, MS 39206-3036
(601) 957-7670
Mailing address
1901 LINDA LN, JACKSON, MS 39213-4448
(601) 941-7102

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
MS

Other

Enumeration date
07/08/2025
Last updated
07/08/2025
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