Healthcare Provider Details

I. General information

NPI: 1164702825
Provider Name (Legal Business Name): JENNIFER HOLDEN ALLEYN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LEIGH HOLDEN M.D.

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5582
  • Fax: 601-984-5583
Mailing address:
  • Phone: 601-984-5582
  • Fax: 601-984-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number822-L
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: