Healthcare Provider Details

I. General information

NPI: 1831679869
Provider Name (Legal Business Name): JARETT LAWRENCE POLLAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RAWLS DR STE 100
MCCOMB MS
39648-2852
US

IV. Provider business mailing address

PO BOX 490
MCCOMB MS
39649-0490
US

V. Phone/Fax

Practice location:
  • Phone: 601-684-2481
  • Fax: 601-684-2488
Mailing address:
  • Phone: 601-249-2701
  • Fax: 601-249-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902695
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: