Healthcare Provider Details

I. General information

NPI: 1225849268
Provider Name (Legal Business Name): SHERRALL LECELLA JENKINS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7118 S SIWELL RD STE B-1
BYRAM MS
39272-8744
US

IV. Provider business mailing address

310 W WOODROW WILSON AVE STE 300
JACKSON MS
39213-7697
US

V. Phone/Fax

Practice location:
  • Phone: 601-373-0354
  • Fax:
Mailing address:
  • Phone: 601-366-9020
  • Fax: 601-321-3979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1113
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11565
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: