Individual
LEIGH ELLEN GAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4500 I 55 N STE 128, JACKSON, MS 39211-5960
(601) 374-7411
Mailing address
104 ROSALIE CT, CLINTON, MS 39056-6053
(601) 946-8888
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903519
MS
Other
Enumeration date
09/23/2019
Last updated
01/31/2022
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