Individual
MRS. JESSICA AMANDA MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
502 BROAD ST, COLUMBIA, MS 39429-3037
(601) 736-8282
(601) 736-8333
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 736-8282
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R861305
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03824030
—
MS
01
—
7886167
CIGNA
MS
Enumeration date
06/05/2009
Last updated
07/23/2020
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