Healthcare Provider Details

I. General information

NPI: 1285453605
Provider Name (Legal Business Name): JENA HERRINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL LN
FOREST MS
39074-4039
US

IV. Provider business mailing address

PO BOX D
FOREST MS
39074-0558
US

V. Phone/Fax

Practice location:
  • Phone: 601-469-3320
  • Fax:
Mailing address:
  • Phone: 601-469-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number906909
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: