Individual
LATRICE BEALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
125 W NORTHSIDE DR # G, JACKSON, MS 39206-4723
(601) 720-2865
Mailing address
7025 HIGHWAY 25, BRANDON, MS 39047-8288
(601) 720-2865
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01775546
—
MS
Enumeration date
03/25/2015
Last updated
03/25/2015
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