Healthcare Provider Details

I. General information

NPI: 1811642176
Provider Name (Legal Business Name): JAMIE LEE MORALES AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE LEE DANIEL RN

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4381 S EASON BLVD STE 301
TUPELO MS
38801-6584
US

IV. Provider business mailing address

1230 CLAYTON AVE
TUPELO MS
38804-1825
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-3008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number906304
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: