Individual
JENNIFER CHAMPAGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2797 COOPER RD, PICAYUNE, MS 39466-2213
(601) 799-1616
Mailing address
30030 ROAD 202, CARRIERE, MS 39426-9208
(601) 590-1459
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R871326
MS
363LG0600X
Gerontology Nurse Practitioner
R871326
MS
363LP2300X
Primary Care Nurse Practitioner
R871326
MS
Other
Enumeration date
01/26/2015
Last updated
07/21/2016
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