Individual
DORETHA BOURNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
354 CUB BROWN RD, MONTICELLO, MS 39654-7505
(601) 587-4629
Mailing address
354 CUB BROWN RD, MONTICELLO, MS 39654-7505
(601) 587-4629
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R858932
MS
Other
Enumeration date
09/09/2013
Last updated
09/09/2013
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