Individual
GRACE ANN MAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
1200 N STATE ST STE 430, JACKSON, MS 39202-2027
(601) 487-7141
Mailing address
1640 VICKLAN ST, VICKSBURG, MS 39180-3954
(662) 902-5236
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
903061
MS
Other
Enumeration date
12/10/2018
Last updated
03/07/2019
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