Individual
CHARLES ALLEN BRUCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1238 HIGHWAY 42, SUMRALL, MS 39482-9519
(601) 758-3100
(601) 758-3060
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 758-3100
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
901427
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09931583
—
MS
Enumeration date
01/11/2016
Last updated
07/24/2020
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