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NPI Code Detail

MEDICARE: JENNA MORDECAI FNP-C

MEDICARE: JENNA MORDECAI FNP-C
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
1363LF0000XFamily Nurse Practitioner901764MS

General Provider Information

NPI Number : 1336699578
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA MORDECAI FNP-C
Provider Business Mailing Address
First Line : 129 N BROOKMOORE DR
Second Line :
City : COLUMBUS
State : MS
Zip : 39705-2024
Country : US
Telephone Number : 662-329-3838
Fax Number : 662-329-2515
Provider Business Practice Location Address
First Line : 129 N BROOKMOORE DR
Second Line :
City : COLUMBUS
State : MS
Zip : 39705-2024
Country : US
Telephone Number : 662-329-3838
Fax Number : 662-329-2515
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2016
Last Update Date : 10/16/2024

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Directions to “ JENNA MORDECAI FNP-C” Practice Location

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