Provider Demographics
NPI:1437520053
Name:MIRE, JENNIFER JONES (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JONES
Last Name:MIRE
Suffix:
Gender:F
Credentials:FNP
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
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4792
Mailing Address - Country:US
Mailing Address - Phone:601-446-7343
Mailing Address - Fax:601-445-0833
Practice Address - Street 1:46 SERGEANT PRENTISS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4792
Practice Address - Country:US
Practice Address - Phone:601-446-7343
Practice Address - Fax:601-445-0833
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine