Individual
MRS. ADDIE PARKS HERROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
1668 W PEACE ST, CANTON, MS 39046-5332
(601) 859-5213
(601) 859-8777
Mailing address
PO BOX 588, CANTON, MS 39046-0588
(601) 859-5213
(601) 859-8771
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R715247
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05179077
—
MS
05
—
08184344
—
MS
Enumeration date
10/04/2006
Last updated
05/25/2016
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