Healthcare Provider Details

I. General information

NPI: 1386392298
Provider Name (Legal Business Name): SHELLY KIMBERLYN SARRETT CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

504 CLINTON CENTER DR STE 4300
CLINTON MS
39056-5610
US

V. Phone/Fax

Practice location:
  • Phone: 662-532-1543
  • Fax: 662-532-1544
Mailing address:
  • Phone: 888-815-2005
  • Fax: 601-815-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number904278
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: