Provider Demographics
NPI:1417662925
Name:FARRIS, JENNY KATHERINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:KATHERINE
Last Name:FARRIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 COUNTY ROAD 28
Mailing Address - Street 2:
Mailing Address - City:DENNIS
Mailing Address - State:MS
Mailing Address - Zip Code:38838-9735
Mailing Address - Country:US
Mailing Address - Phone:662-279-0841
Mailing Address - Fax:
Practice Address - Street 1:12725 HIGHWAY 23 N
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:MS
Practice Address - Zip Code:38876-8735
Practice Address - Country:US
Practice Address - Phone:662-652-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily