Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R855650 | MS |
NPI | 1164683702 |
---|---|
Provider Name | Jennifer Richardson |
First Address | Jackson, MS 39216-5000 |
Second Address | Jackson, MS 39216-5000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 12/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06939583 | (05) | MS |