Individual
JALEESA NICOLE EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
330B HIGHWAY 90, GAUTIER, MS 39553-5744
(228) 497-0690
Mailing address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
912487
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018214
—
MS
Enumeration date
07/30/2019
Last updated
09/10/2025
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