MEDICARE: DR. JENNIFER K. MYERS M.D.

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	208000000X	Pediatrics Physician	16522	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902917206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER K. MYERS M.D.

Provider Business Mailing Address
First Line	:	120 SCARBROUGH ST STE A
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-9798
Country	:	US
Telephone Number	:	601-362-8776
Fax Number	:	601-398-9881

Provider Business Practice Location Address
First Line	:	120 SCARBROUGH ST STE A
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-9798
Country	:	US
Telephone Number	:	601-362-8776
Fax Number	:	601-398-9881

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/10/2024

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