Individual
TEKETRA EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN, COSMETOLOGIST
Contact information
Practice address
39 E ZION RD, WIGGINS, MS 39577-5000
(601) 606-4269
Mailing address
107 WALTER PAYTON DR # 222, COLUMBIA, MS 39429-3738
(601) 228-1301
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/24/2019
Last updated
10/24/2019
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