Healthcare Provider Details

I. General information

NPI: 1164683702
Provider Name (Legal Business Name): JENNIFER RICHARDSON NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER RICHARDSON NNP-BC

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 LAKELAND DR STE C
JACKSON MS
39216-5000
US

IV. Provider business mailing address

1991 LAKELAND DR STE C
JACKSON MS
39216-5000
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-5887
  • Fax: 601-981-7935
Mailing address:
  • Phone: 601-981-5887
  • Fax: 601-981-7935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberR855650
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: