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General NPI Number Information
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NPI Number | 1174872626
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Entity Type | Individual
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Provider Name | JENNIFER B WARREN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 3495 COBBLESTONE BLVD S
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City | SOUTHAVEN
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State | MS
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Zip | 38672-7075
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Country | US
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Telephone | 662-892-2885
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Fax | 662-890-1551
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Provider Business Mailing Address
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Address Line | 3495 COBBLESTONE BLVD S
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City | SOUTHAVEN
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State | MS
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Zip | 38672-7075
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Country | US
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Telephone | 662-892-2885
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Fax | 662-890-1551
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R879367
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R879367
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License Number State | MS
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