Individual
CAROLE RIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
418 W MINNESOTA ST, BROOKHAVEN, MS 39601-3764
(601) 669-1995
Mailing address
418 W MINNESOTA ST, BROOKHAVEN, MS 39601-3764
(601) 669-1995
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATO457
MS
Other
Enumeration date
11/17/2014
Last updated
11/17/2014
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