Healthcare Provider Details

I. General information

NPI: 1104603653
Provider Name (Legal Business Name): JAMELMENIQUE UNKIROSHAY HOY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SWINNEA RDG STE 2
SOUTHAVEN MS
38671-6013
US

IV. Provider business mailing address

3050 BRYANT ST
SOUTHAVEN MS
38672-1007
US

V. Phone/Fax

Practice location:
  • Phone: 662-228-4529
  • Fax: 662-200-5988
Mailing address:
  • Phone: 662-719-4504
  • Fax: 662-200-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906261
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number34665
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: