Healthcare Provider Details

I. General information

NPI: 1053290809
Provider Name (Legal Business Name): BERNESHA LA'SHA MCLEMORE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 E CAPITOL ST STE 700
JACKSON MS
39201-2144
US

IV. Provider business mailing address

510 DUBLIN DR
COLUMBUS MS
39702-5538
US

V. Phone/Fax

Practice location:
  • Phone: 844-809-8438
  • Fax:
Mailing address:
  • Phone: 601-746-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907730
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: