Individual
JANICE JOHNSON TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
5429 ROBINSON ROAD EXT, JACKSON, MS 39204-4138
(601) 914-0163
(601) 914-0170
Mailing address
2050 RUSSELL J TILLMAN RD, EDWARDS, MS 39066-9101
(601) 988-3728
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
884780
MS
363LF0000X
Family Nurse Practitioner
Primary
904041
MS
Other
Enumeration date
03/06/2020
Last updated
06/21/2021
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