Provider Demographics
NPI:1154888535
Name:RANKIN, JALEN
Entity type:Individual
Prefix:
First Name:JALEN
Middle Name:
Last Name:RANKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:PRENTISS
Mailing Address - State:MS
Mailing Address - Zip Code:39474-6004
Mailing Address - Country:US
Mailing Address - Phone:601-317-6725
Mailing Address - Fax:
Practice Address - Street 1:1437 THIRD ST
Practice Address - Street 2:
Practice Address - City:PRENTISS
Practice Address - State:MS
Practice Address - Zip Code:39474-6004
Practice Address - Country:US
Practice Address - Phone:601-317-6725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver