Healthcare Provider Details

I. General information

NPI: 1184325797
Provider Name (Legal Business Name): JASMINI NEENA BOWEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 MILL STREET EXT STE D
LUCEDALE MS
39452-6079
US

IV. Provider business mailing address

2210 MILL STREET EXT STE D
LUCEDALE MS
39452-6079
US

V. Phone/Fax

Practice location:
  • Phone: 601-791-5004
  • Fax:
Mailing address:
  • Phone: 601-791-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number905884
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: