Individual
JERRY C COLLADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CFNP
Contact information
Practice address
6919 OLD CANTON RD, RIDGELAND, MS 39157-1268
(601) 956-0911
(601) 957-8439
Mailing address
2500 NORTH STATE STREET, JMM SUITE 2525, JACKSON, MS 39216-4500
(601) 815-9528
(601) 984-6439
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R862534
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302I502230
MEDICARE PTAN
MS
Enumeration date
05/28/2009
Last updated
08/27/2018
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