Individual
JACQUELYN B ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, NP-C
Contact information
Practice address
4105 HOSPITAL ROAD, STE 103, PASCAGOULA, MS 39581
(228) 762-8712
Mailing address
116 MILL STREET EXT, LUCEDALE, MS 39452-3492
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
903206
MS
Other
Enumeration date
04/10/2019
Last updated
04/10/2019
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