Healthcare Provider Details

I. General information

NPI: 1295240414
Provider Name (Legal Business Name): JENNA SCRUGGS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SOUTHCREST CIR
SOUTHAVEN MS
38671-6726
US

IV. Provider business mailing address

2120 EXETER RD STE 250
GERMANTOWN TN
38138-3931
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-0488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23699
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902443
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: