Provider Demographics
NPI:1649390782
Name:MCCOLLUM, JOANNA R (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:R
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:CFNP
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Mailing Address - Street 1:1860 CHADWICK DR
Mailing Address - Street 2:SUITE 254
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3463
Mailing Address - Country:US
Mailing Address - Phone:601-376-2818
Mailing Address - Fax:601-376-2831
Practice Address - Street 1:1860 CHADWICK DR
Practice Address - Street 2:SUITE 254
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3463
Practice Address - Country:US
Practice Address - Phone:601-376-2818
Practice Address - Fax:601-376-2831
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR859382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner