Individual
JENNIFER WEDGEWORTH MOONEYHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1127 OLD FANNIN RD, SUITE C, BRANDON, MS 39047-9265
(601) 214-4420
Mailing address
1127 OLD FANNIN RD, SUITE C, BRANDON, MS 39047-9265
(601) 214-4420
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R845026
MS
Other
Enumeration date
04/26/2007
Last updated
12/30/2010
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