=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659225886
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVENTURE PEDIATRICS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2026
-----------------------------------------------------
Last Update Date | 02/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5960 GETWELL RD STE 102-103
-----------------------------------------------------
City | SOUTHAVEN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38672-7318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-443-4408
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5960 GETWELL RD STE 102-103
-----------------------------------------------------
City | SOUTHAVEN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38672-7318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JENNIFER O'BRYAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 662-443-4408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------