| Doctor Name: | MARY SHAREE TILL |
| NPI Number: | 1154572857 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ACNP-BC |
| License Number: | R803122 |
| Business Practice Address: | 109 E Quitman St Suite A Iuka, MS - 388521936 |
| Business Phone Number: | 6624235007 |
| Business Fax Number: | 6624235050 |
| Mailing Address: | 109 E Quitman St, Suite A IUKA |
| State: | MS |
| Postal Code: | 388521936 |
| Phone Number: | 6624235007 |
| Fax Number: | 6624235050 |
| NPI Enumeration Date: | 10/01/2008 |
| NPI Last Update Date: | 01/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | R803122 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |