Individual
MRS. TIFFANY EDWARDS KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS, PA-C
Contact information
Practice address
1220 JEFFERSON ST, LAUREL, MS 39440-4355
(601) 426-4000
(601) 426-4105
Mailing address
PO BOX 247, LAUREL, MS 39441-0247
(601) 399-6169
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
MA058228
PA
363AM0700X
Medical Physician Assistant
Primary
PA00374
MS
Other
Enumeration date
03/31/2016
Last updated
11/05/2018
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