Individual
CANTRELL OLLIE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1225 N STATE ST, JACKSON, MS 39202-2064
(601) 968-1031
Mailing address
PO BOX 2153 DEPT 1947, BIRMINGHAM, AL 35287-0001
(901) 226-3186
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
906306
MS
Other
Enumeration date
10/03/2021
Last updated
09/13/2024
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