Individual
MRS. JACQUELINE ANN CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5610
(601) 984-5783
Mailing address
PO BOX 22727, JACKSON, MS 39225-2727
(601) 200-4749
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R752134
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09120238
—
MS
01
—
302I507415
MEDICARE PTAN
MS
Enumeration date
04/26/2007
Last updated
03/07/2023
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