Individual
ROCHELLE VANITY CORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4635 US-80, PEARL, MS 39208
(601) 933-2500
Mailing address
4635 US-80, PEARL, MS 39208
(601) 933-2500
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
903496
MS
363LG0600X
Gerontology Nurse Practitioner
903496
MS
363LP2300X
Primary Care Nurse Practitioner
Primary
903496
MS
Other
Enumeration date
03/12/2020
Last updated
03/12/2020
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