Doctor Name: | MARTHA MAXINE PUCKETT |
NPI Number: | 1104808732 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | R518425 |
Business Practice Address: | 14365 Highway 16 W De Kalb, MS - 393287974 |
Business Phone Number: | 6017434626 |
Business Fax Number: | 6017432133 |
Mailing Address: | 1314 19th Ave, MERIDIAN |
State: | MS |
Postal Code: | 393014116 |
Phone Number: | 6017034282 |
Fax Number: | 6017034597 |
NPI Enumeration Date: | 11/18/2005 |
NPI Last Update Date: | 11/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R518425 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |