Healthcare Provider Details

I. General information

NPI: 1639647761
Provider Name (Legal Business Name): LEXIE HUNT MCLENDON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date: 02/20/2019
Reactivation Date: 02/27/2019

III. Provider practice location address

1225 N STATE ST
JACKSON MS
39202-2064
US

IV. Provider business mailing address

PO BOX 2204
MADISON MS
39130-2204
US

V. Phone/Fax

Practice location:
  • Phone: 833-672-8767
  • Fax:
Mailing address:
  • Phone: 833-672-8767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902657
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: