Healthcare Provider Details

I. General information

NPI: 1437694320
Provider Name (Legal Business Name): KRISTEN DEGELMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 LAKELAND DR
JACKSON MS
39216-4606
US

IV. Provider business mailing address

1031 N FLOWOOD DR
FLOWOOD MS
39232-9533
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-3631
  • Fax:
Mailing address:
  • Phone: 601-203-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901888
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: