Individual
MRS. MARY ELIZABETH TULLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3451 GOODMAN RD E STE 115, SOUTHAVEN, MS 38672-9304
(662) 890-5555
(662) 890-8899
Mailing address
3451 GOODMAN RD E STE 115, SOUTHAVEN, MS 38672-9304
(662) 890-5555
(662) 890-8899
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
13240
TN
363LF0000X
Family Nurse Practitioner
Primary
869304
MS
363LF0000X
Family Nurse Practitioner
R869304
MS
Other
Enumeration date
06/12/2008
Last updated
10/05/2023
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