Individual
MS. BETHANY BRELAND CASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN,WHNP-BC, AGNP-BC
Contact information
Practice address
2500 NORTH STATE STREET, JACKSON, MS 39216-4500
(601) 815-4128
(601) 815-1828
Mailing address
2500 NORTH STATE STREET, JMM ROOM 2525, JACKSON, MS 39216-4500
(601) 984-6426
(601) 984-6439
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
R860365
MS
363LW0102X
Women's Health Nurse Practitioner
Primary
R860365
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03727355
—
MS
Enumeration date
04/09/2009
Last updated
01/13/2016
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