Healthcare Provider Details

I. General information

NPI: 1013699057
Provider Name (Legal Business Name): JOCELYN PATRICE SEAWOOD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17280 MS-17
LEXINGTON MS
39095
US

IV. Provider business mailing address

105 JACKS RUN
MADISON MS
39110-6882
US

V. Phone/Fax

Practice location:
  • Phone: 662-834-1857
  • Fax:
Mailing address:
  • Phone: 662-582-6853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906137
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: