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General NPI Number Information
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NPI Number | 1245117845
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Entity Type | Individual
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Provider Name | JESSICA TERRY PA-C, RDH
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Gender | Female
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 4331 HIGHWAY 39 N
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City | MERIDIAN
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State | MS
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Zip | 39301-1007
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Country | US
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Telephone | 601-693-1044
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Fax |
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Provider Business Mailing Address
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Address Line | 3911 PENINSULA DR
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City | LAUDERDALE
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State | MS
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Zip | 39335-9542
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Country | US
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Telephone | 601-503-4197
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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