Individual
LAKITTA SHUNTEL BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7721 HACKS CROSS RD STE 114, OLIVE BRANCH, MS 38654-3909
(901) 461-2756
(662) 796-6432
Mailing address
7721 HACKS CROSS RD STE 114, OLIVE BRANCH, MS 38654-3909
(901) 461-2756
(662) 796-6432
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
557970
MS
Other
Enumeration date
06/16/2022
Last updated
06/23/2022
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