Provider Demographics
NPI:1174849269
Name:HEBERT, JENNIFER L (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HEBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SERGEANT PRENTISS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4751
Mailing Address - Country:US
Mailing Address - Phone:601-445-1715
Mailing Address - Fax:
Practice Address - Street 1:46 SERGEANT PRENTISS DR STE 201
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4751
Practice Address - Country:US
Practice Address - Phone:601-445-1715
Practice Address - Fax:601-445-6720
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206649207R00000X
390200000X
MS28958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA533044ZK07Medicare PIN