Individual
MARY FOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2803 ATTALA ROAD 2207, KOSCIUSKO, MS 39090-3163
(662) 770-1315
Mailing address
2803 ATTALA ROAD 2207, KOSCIUSKO, MS 39090-3163
(662) 770-1315
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704303249
MI
Other
Enumeration date
03/13/2017
Last updated
03/13/2017
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