Individual
JACLYN OWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
92 RATLIFF ST, LUCEDALE, MS 39452-6537
(601) 947-8181
(601) 947-4411
Mailing address
14515 LORRAINE RD, BILOXI, MS 39532-7421
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00942
MS
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/29/2024
Last updated
03/04/2026
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