Individual
MS. CRISTINA SULLIVAN LEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
104 BURNEY DR, FLOWOOD, MS 39232-6621
(601) 987-8200
Mailing address
104 BURNEY DR, FLOWOOD, MS 39232-6621
(601) 506-2297
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA00516
MS
363AS0400X
Surgical Physician Assistant
Primary
PA00516
MS
Other
Enumeration date
01/04/2021
Last updated
12/13/2022
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