Provider Demographics
NPI:1336954361
Name:MOBLEY, JESSICA LYNETTE
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNETTE
Last Name:MOBLEY
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 1:3712 OLD MOBILE AVE STE L
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-3767
Mailing Address - Country:US
Mailing Address - Phone:228-215-1760
Mailing Address - Fax:
Practice Address - Street 1:3712 OLD MOBILE AVE STE L
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-3767
Practice Address - Country:US
Practice Address - Phone:228-215-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3747P1801X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant