Healthcare Provider Details

I. General information

NPI: 1356646772
Provider Name (Legal Business Name): JILLIAN M STRAYHAM N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN M LADNER N.P.

II. Dates (important events)

Enumeration Date: 01/15/2011
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8006 HIGHWAY 613
MOSS POINT MS
39562-8200
US

IV. Provider business mailing address

4500 13TH ST
GULFPORT MS
39501-2515
US

V. Phone/Fax

Practice location:
  • Phone: 228-475-1166
  • Fax: 228-475-9337
Mailing address:
  • Phone: 228-239-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR876026
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: