Individual
KENITRA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
145 HOMOCHITTO ST, NATCHEZ, MS 39120
(601) 442-4863
Mailing address
145 HOMOCHITTO ST, NATCHEZ, MS 39120-3906
(601) 442-4863
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902181
MS
Other
Enumeration date
07/19/2017
Last updated
05/23/2018
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