Individual
JENNIFER B WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3495 COBBLESTONE BLVD S, SOUTHAVEN, MS 38672-7075
(662) 892-2885
(662) 890-1551
Mailing address
3495 COBBLESTONE BLVD S, SOUTHAVEN, MS 38672-7075
(662) 892-2885
(662) 890-1551
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
R879367
MS
363LF0000X
Family Nurse Practitioner
Primary
R879367
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01028095
—
MS
Enumeration date
08/30/2012
Last updated
03/22/2022
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