Healthcare Provider Details

I. General information

NPI: 1659059095
Provider Name (Legal Business Name): JAN MARIE VALENTI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 KATHERINE DR
FLOWOOD MS
39232-9588
US

IV. Provider business mailing address

215 KATHERINE DR
FLOWOOD MS
39232-9588
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 855-830-3484
Mailing address:
  • Phone: 601-665-4162
  • Fax: 855-830-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number905952
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: