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General NPI Number Information
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NPI Number | 1952071227
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Entity Type | Individual
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Provider Name | JESSICA FAYE SKINNER NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/17/2021
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 351 PEOPLES DR
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City | PONTOTOC
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State | MS
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Zip | 38863-8990
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Country | US
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Telephone | 601-438-2678
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Fax |
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Provider Business Mailing Address
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Address Line | 1834 PARKER ROBERSON RD
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City | MABEN
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State | MS
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Zip | 39750-8923
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Country | US
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Telephone |
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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 | 904546
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License Number State | MS
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