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Individual

PAULA DECANTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
1755 COUNTY ROAD 81, BLUE MOUNTAIN, MS 38610-9657
(662) 538-4111
(662) 538-4128
Mailing address
1755 COUNTY ROAD 81, BLUE MOUNTAIN, MS 38610-9657
(662) 538-4111
(662) 538-4128

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R819565
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0121560
MS
Enumeration date
01/24/2006
Last updated
10/08/2013
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