MEDICARE: JODY T ADAMS CFNP

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	363LF0000X	Family Nurse Practitioner	R688797	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00062082	OTHER	MS	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	753068151001	OTHER	MS	TRICARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	753068151	OTHER	MS	MS HEALTH PARTNERS
4	753068151	OTHER	MS	MS PHYSICIANS CARE NETWOR
5	168390703	OTHER	MS	US DEPT OF LABOR

General Provider Information

NPI Number	:	1780652362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY T ADAMS CFNP

Provider Business Mailing Address
First Line	:	587 HIGHWAY 51 STE T
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2567
Country	:	US
Telephone Number	:	601-790-7711
Fax Number	:	601-790-7712

Provider Business Practice Location Address
First Line	:	728 CLINTON PKWY
Second Line	:	SUITE B
City	:	CLINTON
State	:	MS
Zip	:	39056-5227
Country	:	US
Telephone Number	:	601-200-4800
Fax Number	:	601-924-0473

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	12/08/2020

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