Healthcare Provider Details

I. General information

NPI: 1043099674
Provider Name (Legal Business Name): LADONNA PYBUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 S PARKWAY ST
CORINTH MS
38834-6563
US

IV. Provider business mailing address

4807 RAMER SELMER RD
SELMER TN
38375-5441
US

V. Phone/Fax

Practice location:
  • Phone: 662-536-6210
  • Fax:
Mailing address:
  • Phone: 469-855-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP-0990
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: