Provider Demographics
NPI:1598954653
Name:RAVENSTEIN, JENNIFER LEWIS (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEWIS
Last Name:RAVENSTEIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:RAVENSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CFNP
Mailing Address - Street 1:421 SUMMERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6923
Mailing Address - Country:US
Mailing Address - Phone:601-942-3648
Mailing Address - Fax:769-300-2953
Practice Address - Street 1:1000 HIGHLAND COLONY PKWY
Practice Address - Street 2:STE 27202
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2073
Practice Address - Country:US
Practice Address - Phone:769-300-2946
Practice Address - Fax:769-300-2953
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR864312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I505568Medicare PIN