Individual
MRS. SUSAN ELYSE MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
7736 AIRWAYS BLVD, SOUTHAVEN, MS 38671-5306
(662) 772-5222
(662) 772-5957
Mailing address
965 RIDGE LAKE BLVD STE 315, MEMPHIS, TN 38120-9401
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
27393
TN
363LF0000X
Family Nurse Practitioner
Primary
903762
MS
Other
Enumeration date
06/19/2020
Last updated
04/19/2022
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