Healthcare Provider Details

I. General information

NPI: 1134053846
Provider Name (Legal Business Name): JENNI BAXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S GLOSTER ST
TUPELO MS
38801-4934
US

IV. Provider business mailing address

324 ALBEMARLE DR
HOOVER AL
35226-1503
US

V. Phone/Fax

Practice location:
  • Phone: 662-346-1124
  • Fax:
Mailing address:
  • Phone: 662-346-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number927876
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: