MEDICARE: JENNA GADDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	R901658	MS

General Provider Information

NPI Number	:	1114470143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA GADDY

Provider Business Mailing Address
First Line	:	104 W RAILROAD AVE S
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2111
Country	:	US
Telephone Number	:	601-892-3063
Fax Number	:	888-927-0375

Provider Business Practice Location Address
First Line	:	104 W RAILROAD AVE S
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2111
Country	:	US
Telephone Number	:	601-892-3063
Fax Number	:	888-927-0375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	11/18/2025

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Directions to “ JENNA GADDY ” Practice Location

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