Healthcare Provider Details

I. General information

NPI: 1144687583
Provider Name (Legal Business Name): JERAD ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR
JACKSON MS
39216-4643
US

IV. Provider business mailing address

971 LAKELAND DR
JACKSON MS
39216-4643
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-4230
  • Fax: 601-664-6694
Mailing address:
  • Phone: 601-939-4230
  • Fax: 601-664-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number882802
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: