Individual
JUANITA IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
102 FRANKLIN ST, OXFORD, MS 38655-8166
(662) 607-1388
Mailing address
102 FRANKLIN ST, OXFORD, MS 38655-8166
(662) 607-1388
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
900869
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
907855
MS
Other
Enumeration date
09/23/2025
Last updated
10/10/2025
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