Individual
MIA BEN'NA DURRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 FOXGATE AVE APT 31D, HATTIESBURG, MS 39402-1840
(601) 597-9960
Mailing address
PO BOX 142, FAYETTE, MS 39069-0142
(601) 597-9960
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NLM131887957001
BLUE CROSS BLUE SHIELD
MS
Enumeration date
10/17/2022
Last updated
10/17/2022
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