Provider Demographics
NPI:1043225576
Name:JURNEY, NINA P (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:P
Last Name:JURNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-1100
Mailing Address - Country:US
Mailing Address - Phone:601-849-1682
Mailing Address - Fax:601-849-5179
Practice Address - Street 1:502 JACKSON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-3300
Practice Address - Country:US
Practice Address - Phone:662-369-9945
Practice Address - Fax:662-304-4007
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR729914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS120672Medicaid
MS120672Medicaid
MS500002082Medicare PIN