Healthcare Provider Details

I. General information

NPI: 1568719540
Provider Name (Legal Business Name): JACQUELINE D BOYD-DRUMMOND FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE D BOYD-DRUMMOND

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 SOUTHERLAND ST STE 100
JACKSON MS
39216-4855
US

IV. Provider business mailing address

163 DRUMMOND RD
MENDENHALL MS
39114-4348
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4429
  • Fax: 612-500-4737
Mailing address:
  • Phone: 662-719-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF08170574
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: