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CHARLES ALLEN BRUCE FNP-C

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1740646421

Individual Registrant:
 CHARLES ALLEN BRUCE FNP-C
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1238 HIGHWAY 42  SUMRALL, MS 39482-9519 US
Tel: 601-758-3100  Fax: 601-758-3060

Contact information for business:
415 S 28TH AVE  HATTIESBURG, MS 39401-7246 US
Tel: 601-758-3100  Fax: 601-579-5240

Registration Information:
NPI: 1740646421
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
MS901427

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
09931583MS05




HEALTH CARE JOBS MS - Page 1



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