Individual
JESSICA ANNE LAUDERDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
11 E JEFFERSON ST, PONTOTOC, MS 38863-2807
(662) 489-6041
Mailing address
11 E JEFFERSON ST, PONTOTOC, MS 38863-2807
(662) 489-6041
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23832
MS
208D00000X
General Practice Physician
L2069591
MI
Other
Enumeration date
08/29/2011
Last updated
11/17/2023
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