Individual
JODI HARDY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
107 EUREKA ST, BATESVILLE, MS 38606-2533
(662) 563-6000
(662) 563-0700
Mailing address
107 EUREKA ST, BATESVILLE, MS 38606-2533
(662) 563-6000
(662) 563-0700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R861526
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03428243
—
MS
01
—
512I500356
PROVIDER TRANSACTION ACCESS NUMBER/PTAN
MS
Enumeration date
09/19/2007
Last updated
08/01/2019
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