Individual
MACKINZIE LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1700 UNIVERSITY BLVD STE 8, JACKSON, MS 39204-3907
(601) 502-4245
Mailing address
4985 SPRINGRIDGE RD, RAYMOND, MS 39154-9492
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
886202
MS
363LF0000X
Family Nurse Practitioner
Primary
904736
MS
Other
Enumeration date
01/05/2021
Last updated
03/07/2022
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