Individual
JENNIFER RUSSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
732 CLINTON PKWY, CLINTON, MS 39056-5227
(601) 924-7994
Mailing address
732 CLINTON PKWY, CLINTON, MS 39056-5227
(601) 924-7994
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R880745
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01633507
—
MS
Enumeration date
07/28/2014
Last updated
09/10/2020
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