Healthcare Provider Details

I. General information

NPI: 1972453033
Provider Name (Legal Business Name): JACQUELINE KAY PHILLIPS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5136 HIGHWAY 80
MORTON MS
39117-3636
US

IV. Provider business mailing address

2288 STAGE RD
MORTON MS
39117-8264
US

V. Phone/Fax

Practice location:
  • Phone: 601-940-2999
  • Fax:
Mailing address:
  • Phone: 601-940-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number908102
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: