Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R879043 | MS |
NPI | 1013302082 |
---|---|
Provider Name | Mrs. Tiffany Griffin |
First Address | Jackson, MS 39209 |
Second Address | Jackson, MS 39209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2015 |
Last Update Date | 07/01/2020 |