Healthcare Provider Details

I. General information

NPI: 1538792320
Provider Name (Legal Business Name): MARKESHIA JENESE BOYD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARKESHIA JENESE BROCK FNP

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WOODLANDS PKWY
RIDGELAND MS
39157-5240
US

IV. Provider business mailing address

PO BOX 475
CANTON MS
39046-0475
US

V. Phone/Fax

Practice location:
  • Phone: 866-686-2504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016668
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24577
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5016668
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904803
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: