Most Relevant Information
Provider Data
| NPI Number: | 1003459595 |
| Provider Name: | DESIREE PATIENCE NICOLE CHUPP |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/28/2019 |
| Last Updated: | 10/28/2019 |
Provider Practice Location
609 E CHURCH ST
BOONEVILLE
MS
388293711
Practice Location Phone/Fax
| Phone: | 6627282488 |
| Fax: |
Provider Mailing Location
860 E RIVER PL
JACKSON
MS
392023442
Provider Mailing Phone/Fax
| Phone: | 7692515550 |
| Fax: |