Healthcare Provider Details

I. General information

NPI: 1962336958
Provider Name (Legal Business Name): JENNIFER REMINGTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 BIG LANE DR STE B
BROOKHAVEN MS
39601-2331
US

IV. Provider business mailing address

5451 RIVER THAMES RD
JACKSON MS
39211-4136
US

V. Phone/Fax

Practice location:
  • Phone: 601-823-8000
  • Fax:
Mailing address:
  • Phone: 601-319-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902950
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: