Individual
LADARYL LORRAINE WATKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
908692
MS
363LF0000X
Family Nurse Practitioner
Primary
904191
MS
Other
Enumeration date
03/01/2019
Last updated
11/17/2021
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