Individual
MS. MARLA V MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1501 ADELINE ST STE 3, HATTIESBURG, MS 39401-6260
(601) 336-8970
(601) 292-6326
Mailing address
1501 ADELINE ST STE 3, HATTIESBURG, MS 39401-6260
(601) 336-9870
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R852476
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000926271
—
MS
01
—
447640ZWDF
MEDICARE INDIVIDUAL PTAN
—
Enumeration date
12/08/2006
Last updated
08/01/2023
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