Healthcare Provider Details

I. General information

NPI: 1295643351
Provider Name (Legal Business Name): TORRI DENIKA JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 REYNOIR ST
BILOXI MS
39530-4130
US

IV. Provider business mailing address

PO BOX 622
WIGGINS MS
39577-0622
US

V. Phone/Fax

Practice location:
  • Phone: 228-432-1571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908743
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: