Individual
TABATHA FANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1300 SUNSET DR STE A, GRENADA, MS 38901-4081
(662) 226-1646
Mailing address
1300 SUNSET DR STE A, GRENADA, MS 38901-4081
(662) 226-1646
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
904539
MS
Other
Enumeration date
03/25/2021
Last updated
03/16/2023
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