Healthcare Provider Details

I. General information

NPI: 1174389712
Provider Name (Legal Business Name): JACENTHA LATRESS MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 F E SELLERS HWY
MONTICELLO MS
39654-9556
US

IV. Provider business mailing address

271 F E SELLERS HWY
MONTICELLO MS
39654-9556
US

V. Phone/Fax

Practice location:
  • Phone: 601-582-5805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906664
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: