Provider Demographics
NPI:1679881312
Name:SOJOURNER, JENNIFER MACH (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MACH
Last Name:SOJOURNER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:MACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:104 W RAILROAD AVE S
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-2111
Mailing Address - Country:US
Mailing Address - Phone:601-892-3063
Mailing Address - Fax:
Practice Address - Street 1:104 W RAILROAD AVE S
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2111
Practice Address - Country:US
Practice Address - Phone:601-892-3063
Practice Address - Fax:601-892-3570
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR873800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily