Provider Demographics
NPI:1902917206
Name:MYERS, JENNIFER K (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:K
Last Name:MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:120 SCARBROUGH ST STE A
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-9798
Mailing Address - Country:US
Mailing Address - Phone:601-362-8776
Mailing Address - Fax:601-398-9881
Practice Address - Street 1:120 SCARBROUGH ST STE A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-9798
Practice Address - Country:US
Practice Address - Phone:601-362-8776
Practice Address - Fax:601-398-9881
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS16522208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0124417Medicaid