Individual
MR. ANTONIO LAKENDRICK CORTEZ MCBETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1225 N STATE ST, JACKSON, MS 39202-2064
(601) 968-1000
Mailing address
577 STORM STORM RD., LENA, MS 39094
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
910807
MS
363L00000X
Nurse Practitioner
Primary
907859
MS
Other
Enumeration date
10/18/2023
Last updated
12/31/2025
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