Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R883213 | MS |
NPI | 1184960437 |
---|---|
Provider Name | Miss Melissa Easley Flanagin |
First Address | Flowood, MS 39232 |
Second Address | Flowood, MS 39232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2012 |
Last Update Date | 16/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00079248 | (05) | MS |