Provider Demographics
NPI:1679855159
Name:EATON, JESSICA W (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:W
Last Name:EATON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4087
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-4087
Mailing Address - Country:US
Mailing Address - Phone:662-844-4911
Mailing Address - Fax:662-844-8275
Practice Address - Street 1:670 CROSSOVER RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4944
Practice Address - Country:US
Practice Address - Phone:662-844-4911
Practice Address - Fax:662-844-8275
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily