Individual
JESSICA POLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
200 MARION AVE, MCCOMB, MS 39648-2706
(601) 250-4324
(601) 250-4325
Mailing address
PO BOX 490, MCCOMB, MS 39649-0490
(601) 250-4366
(601) 250-4367
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
904540
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07678055
—
MS
Enumeration date
03/25/2021
Last updated
01/02/2024
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