Healthcare Provider Details

I. General information

NPI: 1659775732
Provider Name (Legal Business Name): JENNIFER RICHARDSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005A CITY AVE N
RIPLEY MS
38663-1414
US

IV. Provider business mailing address

1005A CITY AVE N
RIPLEY MS
38663-1414
US

V. Phone/Fax

Practice location:
  • Phone: 662-837-2202
  • Fax: 662-837-2254
Mailing address:
  • Phone: 662-837-2202
  • Fax: 662-837-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR864395
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: