Individual
JAKE MARTIN PENICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1225 N STATE ST, JACKSON, MS 39202-2064
(601) 968-1000
Mailing address
107 BENTONWOOD DR, BRANDON, MS 39042-3301
(601) 572-4815
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
901900
MS
Other
Enumeration date
02/01/2024
Last updated
02/07/2024
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