Healthcare Provider Details

I. General information

NPI: 1124662309
Provider Name (Legal Business Name): JAMIE RENEE RAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMIE RENEE RAWSON RN

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 OLD HWY 13 S
MORTON MS
39117
US

IV. Provider business mailing address

321 OLD HWY 13 S
MORTON MS
39117
US

V. Phone/Fax

Practice location:
  • Phone: 601-732-8612
  • Fax: 601-732-8408
Mailing address:
  • Phone: 601-732-8612
  • Fax: 601-732-8408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904881
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: