Provider Demographics
NPI:1346589421
Name:LADNER, JENNAH CLAINE (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:JENNAH
Middle Name:CLAINE
Last Name:LADNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:JENNAH
Other - Middle Name:CLAINE
Other - Last Name:LADNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1137 OCEAN SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564
Mailing Address - Country:US
Mailing Address - Phone:228-875-8291
Mailing Address - Fax:877-504-3044
Practice Address - Street 1:1137 OCEAN SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564
Practice Address - Country:US
Practice Address - Phone:228-875-8291
Practice Address - Fax:877-504-3044
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR880702363LF0000X
MSF1212260363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily