Individual
MARY LIRETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
242 MALLARD DR, BRANDON, MS 39047-7383
(601) 941-7571
Mailing address
242 MALLARD DR, BRANDON, MS 39047-7383
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
906846
MS
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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