Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 904340 | MS |
NPI | 1003405754 |
---|---|
Provider Name | Cynthia Lynn Bean |
First Address | Meridian, MS 39301-4116 |
Second Address | Meridian, MS 39301-4116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2021 |
Last Update Date | 15/01/2021 |