Individual
JASMINE T KENCY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5532
(601) 984-6665
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5532
(601) 984-6665
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23788
MS
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
T-2474
MS
208000000X
Pediatrics Physician
23788
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02581273
—
MS
01
—
P01696337
RAILROAD MEDICARE PTAN
MS
Enumeration date
07/05/2011
Last updated
10/18/2016
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