Individual
MRS. KIMBERLIE LA'TASHA MABRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1509 WILLOWBEND DR, GAUTIER, MS 39553-7627
(228) 627-1223
Mailing address
1509 WILLOWBEND DR, GAUTIER, MS 39553-7627
(228) 627-1223
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
905478
MS
363L00000X
Nurse Practitioner
227359
LA
363L00000X
Nurse Practitioner
905478
MS
Other
Enumeration date
08/01/2022
Last updated
07/18/2023
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