Individual
NUTRECIA THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
105 N CHERRY ST, TYLERTOWN, MS 39667-2308
(601) 814-0060
Mailing address
13 CARTO RD, TYLERTOWN, MS 39667-7533
(601) 814-0060
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P319249
MS
Other
Enumeration date
07/03/2013
Last updated
11/18/2020
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