Individual
MS. PHALANECIA FONDRIEA KINCAID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
A2R7M5X9
Contact information
Practice address
402 S MAIN ST, FOREST, MS 39074-4137
(601) 701-7753
Mailing address
402 S MAIN ST, FOREST, MS 39074-4137
(601) 701-7753
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
A2R7M5X9
MS
Other
Enumeration date
08/14/2020
Last updated
08/14/2020
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