Provider Demographics
NPI:1417688789
Name:MARTIN, JESSICA SUMMER (DNP, CNM)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SUMMER
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 ORCHARD BROOK CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-6010
Mailing Address - Country:US
Mailing Address - Phone:601-594-3043
Mailing Address - Fax:
Practice Address - Street 1:520 ORCHARD BROOK CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-6010
Practice Address - Country:US
Practice Address - Phone:601-594-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-18
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS899445163W00000X
MS899592367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse