Provider Demographics
NPI:1265017339
Name:BOUIE, JENNIVIE CHRISHAE (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIVIE
Middle Name:CHRISHAE
Last Name:BOUIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HAWPOND CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111
Mailing Address - Country:US
Mailing Address - Phone:601-405-2956
Mailing Address - Fax:
Practice Address - Street 1:115 HAWPOND CHURCH RD
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111
Practice Address - Country:US
Practice Address - Phone:601-405-2956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS337263164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse