Individual
MRS. JESSICA FUQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1530 BROAD AVE, GULFPORT, MS 39501-3601
(228) 865-1330
(228) 865-1331
Mailing address
38 PASS RD STE A, GULFPORT, MS 39507-3107
(228) 865-1330
(228) 865-1331
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
18863
TN
363LF0000X
Family Nurse Practitioner
Primary
902207
MS
363LF0000X
Family Nurse Practitioner
CNP-02586
NM
Other
Enumeration date
08/02/2014
Last updated
07/21/2022
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