Individual
BLAKLEY J BRACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
1391 BROAD AVE, GULFPORT, MS 39501-2419
(228) 863-8868
Mailing address
223 41ST ST, GULFPORT, MS 39507-3931
(228) 209-5031
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
907156
MS
Other
Enumeration date
02/10/2025
Last updated
03/21/2025
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