Provider Demographics
NPI:1467022574
Name:CARPENTER, JESSICA (PMHNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 HIGHWAY 370
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:MS
Mailing Address - Zip Code:38625-9603
Mailing Address - Country:US
Mailing Address - Phone:662-587-3699
Mailing Address - Fax:
Practice Address - Street 1:304 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-2762
Practice Address - Country:US
Practice Address - Phone:662-638-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904702363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health