Individual
LISA ANNETTE DEMENT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
40128 HAMILTON RD, HAMILTON, MS 39746-9686
(662) 369-2455
(662) 319-2125
Mailing address
PO BOX 1100, MAGEE, MS 39111-1100
(601) 849-6440
(601) 849-7557
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R803971
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123535
—
MS
Enumeration date
06/10/2006
Last updated
07/08/2007
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