Healthcare Provider Details

I. General information

NPI: 1477371508
Provider Name (Legal Business Name): JENNIFER URBAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER JOYCE SUMMERLIN NP

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 BIENVILLE BLVD SUITE B
OCEAN SPRINGS MS
39564
US

IV. Provider business mailing address

2101 HIGHWAY 90
GAUTIER MS
39553-5340
US

V. Phone/Fax

Practice location:
  • Phone: 228-872-1951
  • Fax: 228-875-2410
Mailing address:
  • Phone: 228-497-7576
  • Fax: 228-497-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907010
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: