Healthcare Provider Details

I. General information

NPI: 1982512299
Provider Name (Legal Business Name): JENNIFER KAY MASSEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S PEAR ORCHARD RD STE A&B
RIDGELAND MS
39157-4805
US

IV. Provider business mailing address

386 MUNN RD
MORTON MS
39117-9516
US

V. Phone/Fax

Practice location:
  • Phone: 769-233-8051
  • Fax:
Mailing address:
  • Phone: 601-940-0526
  • Fax: 601-940-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908635
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: