Individual
MABLE C PURNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCMA, MEDICAL DATA
Contact information
Practice address
2460 TERRY RD STE 350, JACKSON, MS 39204-5792
(601) 946-3926
Mailing address
1192 HARVEY CIR, BOLTON, MS 39041-9471
(601) 946-3926
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
Z3X2A4K5
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84-5046661
PRIVATE INSURANCE
MS
05
—
84-5046661
—
MS
Enumeration date
01/07/2021
Last updated
01/07/2021
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