Healthcare Provider Details

I. General information

NPI: 1710260401
Provider Name (Legal Business Name): ASHLEY BROOKS SCHAEFER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2500 NORTH STATE STREET JMM ROOM 2525
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5500
  • Fax: 601-984-5503
Mailing address:
  • Phone: 601-984-5500
  • Fax: 601-984-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR879754
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: