Individual
MAKETTA JENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8677 HALLS FERRY RD, VICKSBURG, MS 39180-7047
(601) 618-8632
Mailing address
2160 S FRONTAGE RD APT 17D, VICKSBURG, MS 39180-5181
(601) 618-8632
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
MS
261QR0208X
Mobile Radiology Clinic/Center
Primary
—
MS
Other
Enumeration date
01/03/2019
Last updated
02/21/2025
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