Individual
FRED ALLEN RAYBURN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP - BC
Contact information
Practice address
848 S MADISON ST, TUPELO, MS 38801-4905
(662) 844-4177
Mailing address
4611 TOXISH RD, PONTOTOC, MS 38863-7080
(662) 488-5658
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903556
MS
Other
Enumeration date
09/26/2019
Last updated
09/26/2019
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