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Individual

BROOK CHANNELLE HUNTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AGACNP

Contact information

Practice address
2500 N STATE ST, CARDIOVASCULAR INTENSIVE CARE UNIT, JACKSON, MS 39216-4500
(601) 815-1575
(601) 815-1577
Mailing address
2500 N STATE ST, CARDIOVASCULAR INTENSIVE CARE UNIT, JACKSON, MS 39216-4500
(601) 815-1575
(601) 815-1577

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R880244
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02739555
MS
01
P01620203
RAILROAD MEDICARE
MS
Enumeration date
07/08/2014
Last updated
10/14/2019
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