Individual
AMEENA BANU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
(601) 815-0434
Mailing address
2500 NORTH STATE STREET, CBO-SUITE 4200, JACKSON, MS 39216-4500
(601) 496-9794
(601) 815-0434
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00461
MS
Other
Enumeration date
01/22/2020
Last updated
01/22/2020
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