Individual
LEASE WORDLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITONER
Contact information
Practice address
1815 WATERSHED DR, STARKVILLE, MS 39759-8471
(662) 312-2737
Mailing address
PO BOX 373, MABEN, MS 39750-0373
(662) 312-2737
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901466
MS
Other
Enumeration date
03/04/2016
Last updated
09/10/2025
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