Individual
TERESA POLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
811 HIGHWAY 49 SOUTH, RICHLAND, MS 39218
(601) 932-5060
(601) 932-5062
Mailing address
PO BOX 180165, RICHLAND, MS 39218
(601) 932-5060
(601) 932-5062
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R694061
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117759
—
MS
Enumeration date
08/22/2008
Last updated
06/13/2014
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