Individual
JACKIE EUGENE BRISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
F.N.P.
Contact information
Practice address
1017 DELAWARE AVE, MCCOMB, MS 39648-3827
(601) 250-1122
(601) 250-0290
Mailing address
PO BOX 1909, MCCOMB, MS 39649-1909
(601) 250-1122
(601) 250-0290
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R862702
MS
Other
Enumeration date
08/10/2006
Last updated
03/12/2008
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