Individual
MRS. JENNIFER SUMRALL GODBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, BC
Contact information
Practice address
2500 NORTH STATE STREET, SURGERY, JACKSON, MS 39216
(601) 984-5678
(601) 984-5638
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5678
(601) 984-5638
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R865457
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05956046
—
MS
Enumeration date
12/21/2007
Last updated
12/16/2014
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