Individual
ALICIA R BERRY-KAHO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
90 AVENDALE ROAD, FAYETTE, MS 39069
(601) 451-5018
(601) 451-5018
Mailing address
PO BOX 2252, FAYETTE, MS 39069-2252
(601) 451-5018
(601) 451-5018
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
320763
MS
Other
Enumeration date
01/10/2022
Last updated
01/10/2022
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