Individual
PATTYE DORRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
415 US HIGHWAY 49 N, TUTWILER, MS 38963-5091
(662) 645-6567
Mailing address
605 ROCKHILL RD, SARDIS, MS 38666-5070
(662) 654-5110
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
902063
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
903062
NURSE PRACTIITONER LICENSE
MS
Enumeration date
08/21/2019
Last updated
08/21/2019
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