Individual
DESTINY GRACE BROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
134 MARION AVE, MCCOMB, MS 39648-3620
(601) 300-8252
Mailing address
134 MARION AVE, MCCOMB, MS 39648-3620
(985) 805-2555
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
906701
MS
Other
Enumeration date
06/08/2024
Last updated
10/01/2024
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