| Organization Name: | MARLA MATHIS, FNP |
| NPI Number: | 1285083238 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARLA MATHIS (OWNER) |
| Mailing Address: | 130 N Main St Petal |
| State: | MS US |
| Postal Code: | 394652345 |
| Phone Number: | 6014670087 |
| Fax Number: | 6014500186 |
| NPI Enumeration Date: | 06/10/2016 |
| NPI Last Update Date: | 06/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 852476 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |