Individual
MRS. GWENDOLYN PITCOCK SHIRLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2149 STATELINE RD W, SOUTHAVEN, MS 38671-1222
(662) 342-1112
(662) 342-1116
Mailing address
3402 TOCOWA RD, COURTLAND, MS 38620-9213
(662) 563-3994
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R858450
MS
Other
Enumeration date
09/02/2009
Last updated
02/09/2010
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