MEDICARE: MRS. JENNIFER LEWIS RAVENSTEIN CFNP

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	R864312	MS

General Provider Information

NPI Number	:	1598954653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LEWIS RAVENSTEIN CFNP

Provider Business Mailing Address
First Line	:	421 SUMMERVILLE DR
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39110-6923
Country	:	US
Telephone Number	:	601-942-3648
Fax Number	:	769-300-2953

Provider Business Practice Location Address
First Line	:	1000 HIGHLAND COLONY PKWY
Second Line	:	STE 27202
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2073
Country	:	US
Telephone Number	:	769-300-2946
Fax Number	:	769-300-2953

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

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	06/03/2015

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