Healthcare Provider Details

I. General information

NPI: 1679881312
Provider Name (Legal Business Name): JENNIFER MACH SOJOURNER CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER J MACH RN

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W RAILROAD AVE S
CRYSTAL SPRINGS MS
39059-2111
US

IV. Provider business mailing address

104 W RAILROAD AVE S
CRYSTAL SPRINGS MS
39059-2111
US

V. Phone/Fax

Practice location:
  • Phone: 601-892-3063
  • Fax: 601-892-3570
Mailing address:
  • Phone: 601-892-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR873800
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: