Healthcare Provider Details

I. General information

NPI: 1417688789
Provider Name (Legal Business Name): JESSICA SUMMER MARTIN DNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 ORCHARD BROOK CT
FLORENCE MS
39073-6010
US

IV. Provider business mailing address

520 ORCHARD BROOK CT
FLORENCE MS
39073-6010
US

V. Phone/Fax

Practice location:
  • Phone: 601-594-3043
  • Fax:
Mailing address:
  • Phone: 601-594-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number899445
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number899592
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: