Organization
INNOVATIVE HEALTHCARE MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATRINA MARIA DRYER CFNP (NURSE PRACTITIONER)
(480) 478-0520
Entity
Organization
Contact information
Practice address
3078 HIGHWAY 98 E, MCCOMB, MS 39648-8267
(601) 205-9994
(480) 478-0633
Mailing address
PO BOX 2049, MCCOMB, MS 39649-2049
(480) 478-0520
(480) 478-0633
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320915
—
AZ
01
—
Z131830
MEDICARE PTAN
AZ
Enumeration date
07/24/2009
Last updated
08/13/2024
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