Individual
MRS. JACKIE C DYESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C. A. P. M. H. N. P.
Contact information
Practice address
3550 HIGHWAY 468 WEST, WHITFIELD, MS 39193-0157
(601) 351-8000
(601) 351-8301
Mailing address
PO BOX 157A, WHITFIELD, MS 39193-0157
(601) 351-8000
(601) 351-8301
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R853574
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05859567
—
MS
Enumeration date
12/28/2006
Last updated
07/08/2007
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