Provider Demographics
NPI:1285178822
Name:GRIFFIN, JESSICA N (CFNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5482 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:ECRU
Mailing Address - State:MS
Mailing Address - Zip Code:38841-8471
Mailing Address - Country:US
Mailing Address - Phone:662-488-8799
Mailing Address - Fax:
Practice Address - Street 1:848 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4905
Practice Address - Country:US
Practice Address - Phone:662-844-4177
Practice Address - Fax:662-844-3077
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR859035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily