Individual
FREDERICK JOSEPH DEBEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
422 MEMORIAL BLVD, PICAYUNE, MS 39466
(601) 798-2151
Mailing address
422 MEMORIAL BLVD, PICAYUNE, MS 39466
(228) 324-6406
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R768485
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01930561
—
MS
Enumeration date
02/12/2007
Last updated
03/21/2013
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