Providence Health, Pllc
NPI #1134795628 in Southaven, Mississippi
Provider Information
- NPI Number
- 1134795628
- Entity Type
- Organization
- Organization Name
- Providence Health, Pllc
- Primary Specialty
- Nurse Practitioner
- Enumeration Date
- Jun 3, 2021
- Last Updated
- Jun 3, 2021
Practice Location
- Address
- 7075 GOLDEN OAKS LOOP W STE 10
- City
- Southaven
- State
- Mississippi
- ZIP Code
- 38671-9012
- Phone
- (901) 486-0439
Authorized Official
- Name
- IRENE WILSON, FNP
- Title
- FNP-C
- Phone
- (901) 486-0439
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner |
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