Individual
MR. JOHN BLAKE ENDRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
2 LENOX CT, JACKSON, MS 39211-4145
(601) 421-3280
Mailing address
383 CLARKDELL RD, CANTON, MS 39046-9465
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
907149
MS
363LF0000X
Family Nurse Practitioner
Primary
907149
MS
Other
Enumeration date
01/27/2025
Last updated
01/27/2025
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