Individual
CLINTON EASOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1225 N STATE ST, JACKSON, MS 39202-2064
(601) 968-1700
Mailing address
1225 N STATE ST, JACKSON, MS 39202-2064
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902085
MS
Other
Enumeration date
06/14/2017
Last updated
06/14/2017
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