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General NPI Number Information
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NPI Number | 1003898859
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Entity Type | Individual
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Provider Name | TINA U. MABRY FNP
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Gender | Female
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 24489 HIGHWAY 80
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City | LAKE
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State | MS
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Zip | 39092-3511
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Country | US
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Telephone | 601-775-3264
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Fax | 601-775-3097
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Provider Business Mailing Address
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Address Line | PO BOX 2065
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City | MERIDIAN
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State | MS
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Zip | 39302-2065
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Country | US
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Telephone | 601-703-4282
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Fax | 601-703-4597
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R588199
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License Number State | MS
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