Provider Demographics
NPI:1073041042
Name:POLEY, JAN SHERLENE (FNP)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:SHERLENE
Last Name:POLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:SHERLENE
Other - Last Name:PADEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:4213 WALLFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HOULKA
Mailing Address - State:MS
Mailing Address - Zip Code:38850-9377
Mailing Address - Country:US
Mailing Address - Phone:662-419-0236
Mailing Address - Fax:
Practice Address - Street 1:8 EAST MADISON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851
Practice Address - Country:US
Practice Address - Phone:662-456-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902031363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner