Individual
BRIANNA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
813 S BEECH ST, PICAYUNE, MS 39466-5017
(601) 569-3924
Mailing address
813 S BEECH ST, PICAYUNE, MS 39466-5017
(601) 569-3924
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000000000
PENDING MEDICAID
—
Enumeration date
06/24/2014
Last updated
06/24/2014
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