Individual
MRS. JESICA DENISE MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2500 NORTH STATE STREET, JACKSON, MS 39216-4500
(601) 984-5452
(601) 815-3322
Mailing address
2500 NORTH STATE STREET, JACKSON, MS 39216-4500
(601) 984-5452
(601) 815-3322
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R872871
MS
363LF0000X
Family Nurse Practitioner
Primary
810649
MS
363LF0000X
Family Nurse Practitioner
8434518-4405
UT
363LF0000X
Family Nurse Practitioner
9416834
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03638074
—
MS
Enumeration date
09/23/2012
Last updated
01/24/2017
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