Healthcare Provider Details

I. General information

NPI: 1770427270
Provider Name (Legal Business Name): JABRIA R TYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RANDALL ST
JACKSON MS
39203-1346
US

IV. Provider business mailing address

725 RANDALL ST
JACKSON MS
39203-1346
US

V. Phone/Fax

Practice location:
  • Phone: 601-715-2216
  • Fax:
Mailing address:
  • Phone: 601-715-2216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberMS012668101702
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: