Provider Demographics
NPI:1669341632
Name:CORNER, Z'CARRA JERMYCE
Entity type:Individual
Prefix:MS
First Name:Z'CARRA
Middle Name:JERMYCE
Last Name:CORNER
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 1:1935 LAKELAND DR STE 900
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5028
Mailing Address - Country:US
Mailing Address - Phone:601-718-2468
Mailing Address - Fax:601-718-2487
Practice Address - Street 1:1935 LAKELAND DR STE 900
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5028
Practice Address - Country:US
Practice Address - Phone:601-718-2468
Practice Address - Fax:601-718-2487
Is Sole Proprietor?:No
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS341244164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse