Healthcare Provider Details

I. General information

NPI: 1437600277
Provider Name (Legal Business Name): JESSICA DUPREE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 HALLS CV
SENATOBIA MS
38668-6620
US

IV. Provider business mailing address

103 HALLS CV
SENATOBIA MS
38668-6620
US

V. Phone/Fax

Practice location:
  • Phone: 662-562-9003
  • Fax:
Mailing address:
  • Phone: 662-562-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number21541
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: