Individual
TAKILA TERRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
361 COUNTY ROAD 222, SHUBUTA, MS 39360-9510
(769) 317-4142
Mailing address
361 COUNTY ROAD 222, SHUBUTA, MS 39360-9510
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
337650
MS
Other
Enumeration date
07/31/2024
Last updated
07/31/2024
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