Individual
MARLENA BRADLEY MIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
421 S 28TH AVE, SUITE 200, HATTIESBURG, MS 39401-7206
(601) 268-5640
(601) 261-3507
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5640
(601) 261-3507
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R879755
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01006292
—
MS
Enumeration date
10/02/2013
Last updated
06/14/2021
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