Individual
MRS. STEPHANIE PERRY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
162 FEATHER LN, SUITE E, CANTON, MS 39046-8510
(601) 859-0140
(601) 510-9643
Mailing address
PO BOX 417, MADISON, MS 39130-0417
(601) 720-5303
(601) 510-9643
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R862558
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00780035
—
MS
Enumeration date
07/20/2005
Last updated
10/20/2015
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