Healthcare Provider Details

I. General information

NPI: 1386575496
Provider Name (Legal Business Name): JENNIFER HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 MARQUETTE RD
BRANDON MS
39042-3038
US

IV. Provider business mailing address

PO BOX 88
BRANDON MS
39043-0088
US

V. Phone/Fax

Practice location:
  • Phone: 601-824-0342
  • Fax:
Mailing address:
  • Phone:
  • Fax: 601-823-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: