Provider Demographics
NPI:1417744046
Name:DODDS, JONATHAN DERICK (APRN PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DERICK
Last Name:DODDS
Suffix:
Gender:
Credentials:APRN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 COUNTY ROAD 8200
Mailing Address - Street 2:
Mailing Address - City:RIENZI
Mailing Address - State:MS
Mailing Address - Zip Code:38865-9302
Mailing Address - Country:US
Mailing Address - Phone:662-808-4957
Mailing Address - Fax:
Practice Address - Street 1:38 COUNTY ROAD 8200
Practice Address - Street 2:
Practice Address - City:RIENZI
Practice Address - State:MS
Practice Address - Zip Code:38865-9302
Practice Address - Country:US
Practice Address - Phone:662-808-4957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907369363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty