Healthcare Provider Details

I. General information

NPI: 1396162715
Provider Name (Legal Business Name): JESSICA LOWERY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E LAYFAIR DR STE 120
FLOWOOD MS
39232-7604
US

IV. Provider business mailing address

201 E LAYFAIR DR STE 120
FLOWOOD MS
39232-7604
US

V. Phone/Fax

Practice location:
  • Phone: 601-414-9263
  • Fax: 601-414-9269
Mailing address:
  • Phone: 601-414-9263
  • Fax: 601-414-9263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number264823
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR867677
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: