Individual
MAVIS PRUDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
136 MLK AVE, TUPELO, MS 38801
(662) 422-1281
Mailing address
PO BOX 594, VERONA, MS 38879-0594
(662) 422-1281
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R637165
MS
Other
Enumeration date
01/15/2021
Last updated
01/15/2021
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