Individual
TARA PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
423 CENTRAL AVE, COLDWATER, MS 38618-3915
(662) 622-7011
Mailing address
400 NORTHWEST PLZ, SENATOBIA, MS 38668-1740
(662) 301-8330
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R880191
MS
Other
Enumeration date
04/06/2015
Last updated
12/01/2021
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