Healthcare Provider Details

I. General information

NPI: 1578084703
Provider Name (Legal Business Name): JENNIFER JAMES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 MARKET ST
FLOWOOD MS
39232-3339
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 855-498-6767
  • Fax: 479-968-1673
Mailing address:
  • Phone: 855-498-6767
  • Fax: 479-968-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902115
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: