Healthcare Provider Details

I. General information

NPI: 1679310197
Provider Name (Legal Business Name): JESSICA R BARNES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 CLIFF GOOKIN BLVD
TUPELO MS
38801-6558
US

IV. Provider business mailing address

2152 S CLA WOOD PL
TUPELO MS
38801-7261
US

V. Phone/Fax

Practice location:
  • Phone: 662-205-0098
  • Fax: 662-495-4079
Mailing address:
  • Phone: 662-401-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberXXXXX
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number906877
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberXXXXX
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: