Provider Demographics
NPI:1679292916
Name:ARMSTRONG, JERRY RYAN (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:RYAN
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WHITE STREET
Mailing Address - Street 2:PO BOX 768
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648
Mailing Address - Country:US
Mailing Address - Phone:601-249-4235
Mailing Address - Fax:601-249-4234
Practice Address - Street 1:110 FRANKLINTON STREET
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-2736
Practice Address - Country:US
Practice Address - Phone:601-684-2173
Practice Address - Fax:601-249-1062
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS884204163W00000X, 363LS0200X
MS905789363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool