Provider Demographics
NPI:1528223005
Name:ROBERTS, JENNIFER REBECCA (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:REBECCA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 N 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-2656
Mailing Address - Country:US
Mailing Address - Phone:601-649-5421
Mailing Address - Fax:601-426-3690
Practice Address - Street 1:1008 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-2656
Practice Address - Country:US
Practice Address - Phone:601-649-5421
Practice Address - Fax:601-426-3690
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21751207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology