Organization
IVYRAINE WOMEN'S CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER FREDRICKSON NP (NP)
(662) 856-8440
Entity
Organization
Contact information
Practice address
3964 GOODMAN RD E STE 131, SOUTHAVEN, MS 38672-8762
(662) 856-8440
Mailing address
3964 GOODMAN RD E STE 131, SOUTHAVEN, MS 38672-8762
(662) 856-8440
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/24/2021
Last updated
12/29/2021
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