Individual
MRS. JENNIFER LEE GOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1117 SUNSET DR, SUITE 104, GRENADA, MS 38901-4080
(662) 226-0110
(662) 226-3700
Mailing address
1117 SUNSET DR, SUITE 104, GRENADA, MS 38901-4080
(662) 226-0110
(662) 226-3700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R875035
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07501378
—
MS
01
—
C03154
PTAN
MS
Enumeration date
06/05/2013
Last updated
06/17/2014
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