Healthcare Provider Details

I. General information

NPI: 1003772799
Provider Name (Legal Business Name): MAGNOLIA NEUROLOGY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2025
Last Update Date: 12/27/2025
Certification Date: 12/26/2025
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: 601-750-1259
  • Fax:
Mailing address:
  • Phone: 601-750-1259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA S LOWERY
Title or Position: OWNER
Credential: NP
Phone: 601-750-1259