Individual
MRS. JILL LEVERETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
100 E MONROE ST, GRENADA, MS 38901-5249
(662) 226-0600
Mailing address
100 E MONROE ST, GRENADA, MS 38901-5249
(662) 226-0600
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R864224
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07538740
—
MS
01
—
R864224
MISSISSIPPI BOARD OF NURSING LICENSE
MS
Enumeration date
08/12/2013
Last updated
06/27/2014
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