Individual
MARLY JILL DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1440 CENTRAL AVE E, WIGGINS, MS 39577-9602
(601) 928-6700
(601) 928-6731
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 575-1194
(228) 575-2917
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
904775
MS
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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