Individual
NICHOLE ANDERSON OWENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2500 N STATE ST, UMMC - DEPARTMENT OF SURGERY, JACKSON, MS 39216-4500
(601) 815-2005
(601) 984-6451
Mailing address
2500 N STATE ST, UMMC - DEPARTMENT OF SURGERY, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R877296
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02459205
—
MS
01
—
P01402442
RR MEDICARE
MS
Enumeration date
08/21/2013
Last updated
12/12/2016
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