Individual
KANIESHIA M MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2569
(228) 867-4000
Mailing address
4500 13TH ST, GULFPORT, MS 39501-2569
(228) 867-4000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
903399
MS
Other
Enumeration date
11/21/2019
Last updated
04/06/2020
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