Individual
MRS. MARY LYDIA HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
501 AVALON WAY STE C, BRANDON, MS 39047-7500
(601) 573-7012
Mailing address
911 CEDAR HILL DR, CLINTON, MS 39056-3701
(601) 594-6335
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
903270
MS
Other
Enumeration date
03/21/2019
Last updated
06/11/2019
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