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Individual

MRS. KOSCHER DENEE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
613 MARQUETTE RD, BRANDON, MS 39042-3038
(601) 824-0342
(601) 824-0349
Mailing address
PO BOX 88, BRANDON, MS 39043-0088
(601) 824-0342

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R865579
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R865579
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
R865579
MS
Enumeration date
10/08/2014
Last updated
03/22/2021
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