Individual
JEAN PENNINGTON MARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
GNP-BC
Contact information
Practice address
115 W MADISON ST, BOLTON, MS 39041-3209
(601) 866-7723
(601) 866-7773
Mailing address
315 E CENTER ST, CANTON, MS 39046-3803
(601) 855-0223
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R860036
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R860036
LICENSE NUMBER
MS
Enumeration date
01/10/2012
Last updated
01/10/2012
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