Individual
TANISHA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8626 AIRWAYS BLVD, SOUTHAVEN, MS 38671-2603
(662) 832-0302
Mailing address
108 BAILEY PATRICIA AVE, OXFORD, MS 38655-7336
(662) 832-0302
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
902907
MS
Other
Enumeration date
09/11/2018
Last updated
09/11/2018
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