Provider Demographics
NPI:1285352864
Name:REYNOLDS, JESSICA (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 COUNTY ROAD 351
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-9492
Mailing Address - Country:US
Mailing Address - Phone:601-480-8737
Mailing Address - Fax:
Practice Address - Street 1:1221 24TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3926
Practice Address - Country:US
Practice Address - Phone:601-486-4210
Practice Address - Fax:601-486-4219
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily