Provider Demographics
NPI:1508553074
Name:ALLEN, JENNA LEIGH ANNE JAMES (NP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH ANNE JAMES
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 COUNTY ROAD 461
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-8787
Mailing Address - Country:US
Mailing Address - Phone:662-816-2805
Mailing Address - Fax:
Practice Address - Street 1:1733 UNIVERSITY AVE STE A
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4196
Practice Address - Country:US
Practice Address - Phone:662-638-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily