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General NPI Number Information
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NPI Number | 1003281916
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Entity Type | Individual
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Provider Name | JENNIFER NICHOLS FOREMAN A-GNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 2500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-984-5657
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 NORTH STATE STREET JMM ROOM 2525
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-984-6426
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Fax | 601-984-6439
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 901418
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 882741
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License Number State | MS
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