Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 14014 | MS |
NPI | 1063479723 |
---|---|
Provider Name | Dr. Sheryll Angela Vincent |
First Address | Jackson, MS 39206-2034 |
Second Address | Jackson, MS 39206-2034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 15/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00116035 | (05) | MS |
F44405 | (02) | MS |