MEDICARE: JENNIFER ELAINE LACROIX FNP, RNFA

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	163WR0006X	Registered Nurse First Assistant	902195	MS
2	363L00000X	Nurse Practitioner	902195	MS
3	363LF0000X	Family Nurse Practitioner	902195	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255869665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ELAINE LACROIX FNP, RNFA

Provider Business Mailing Address
First Line	:	415 S 28TH AVE
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39401-7246
Country	:	US
Telephone Number	:	601-268-5630
Fax Number	:	601-579-5240

Provider Business Practice Location Address
First Line	:	7148 HWY 98 WEST
Second Line	:	SUITE 203
City	:	HATTIESBURG
State	:	MS
Zip	:	39402
Country	:	US
Telephone Number	:	601-268-5630
Fax Number	:

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

Provider Enumeration Date	:	05/30/2017
Last Update Date	:	11/01/2023

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