Individual
MS. ZENOTHA LARRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
Mailing address
3502 W NORTHSIDE DR, JACKSON, MS 39213-4454
(601) 362-5321
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
R877587
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R877587
MISSISSIPPI
MS
Enumeration date
11/15/2012
Last updated
05/16/2016
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