Individual
JESSICA RENEE FORDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3800 I-55 NORTH FRONTAGE RD, SUITE 101, JACKSON, MS 39216
(601) 200-6880
(601) 200-6805
Mailing address
3800 I-55 NORTH FRONTAGE RD, SUITE 101, JACKSON, MS 39216
(601) 200-6880
(601) 200-6805
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
880822
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007388276
—
MS
Enumeration date
08/29/2012
Last updated
12/22/2022
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