Individual
JENNIFER MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
670 LEIGH DR, COLUMBUS, MS 39705-3014
(662) 328-1012
Mailing address
670 LEIGH DR, COLUMBUS, MS 39705-3014
(662) 328-1012
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R857945
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01429835
—
MS
Enumeration date
10/07/2014
Last updated
04/07/2015
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