Healthcare Provider Details

I. General information

NPI: 1356853139
Provider Name (Legal Business Name): TAMMIE R JENKINS MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 HARDY ST STE 10
HATTIESBURG MS
39402-1614
US

IV. Provider business mailing address

57 SHARMONT DR
HATTIESBURG MS
39402-1949
US

V. Phone/Fax

Practice location:
  • Phone: 601-602-2014
  • Fax: 601-602-2015
Mailing address:
  • Phone: 601-323-0671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number870300
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: