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General NPI Number Information
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NPI Number | 1578020459
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Entity Type | Individual
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Provider Name | JACQUELYNE BROWN LITTLE FNP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 616 HIGHWAY 82 W
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City | INDIANOLA
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State | MS
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Zip | 38751-2035
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Country | US
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Telephone | 662-635-8680
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Fax |
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Provider Business Mailing Address
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Address Line | 1716 HIGHWAY 442
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City | DODDSVILLE
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State | MS
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Zip | 38736-9730
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Country | US
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Telephone | 662-588-7075
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 903207
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License Number State | MS
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