MEDICARE: JESSICA TUBBS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R874755	MS

General Provider Information

NPI Number	:	1124574231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA TUBBS

Provider Business Mailing Address
First Line	:	401 E LEE ST
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666-1227
Country	:	US
Telephone Number	:	662-487-0004
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E LEE ST
Second Line	:
City	:	SARDIS
State	:	MS
Zip	:	38666-1227
Country	:	US
Telephone Number	:	662-487-0004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	08/29/2016

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Directions to “ JESSICA TUBBS ” Practice Location

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