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Individual

JISUNG PARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN

Contact information

Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6426
(601) 984-6439
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6426
(601) 984-6439

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R896636
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
03778200
MS
Enumeration date
05/16/2014
Last updated
08/21/2014
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