Individual
JENNIFER ROSS GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP-PC
Contact information
Practice address
102 MEDICAL PARK, HATTIESBURG, MS 39401-9080
(601) 261-5159
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 261-5159
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
865754
MS
363L00000X
Nurse Practitioner
Primary
864754
MS
363LP0200X
Pediatric Nurse Practitioner
865754
MS
Other
Enumeration date
02/04/2020
Last updated
03/25/2025
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