Healthcare Provider Details

I. General information

NPI: 1639033434
Provider Name (Legal Business Name): VERA BRENT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 CLUBVIEW DR
JACKSON MS
39211-4264
US

IV. Provider business mailing address

PO BOX 12003
JACKSON MS
39236-2003
US

V. Phone/Fax

Practice location:
  • Phone: 601-918-9749
  • Fax:
Mailing address:
  • Phone: 601-918-9749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908042
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: