Provider Demographics
NPI:1730141995
Name:MCMINN, JENNIFER LEIGH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:MCMINN
Suffix:
Gender:F
Credentials:FNP
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 88
Mailing Address - Street 2:
Mailing Address - City:POTTS CAMP
Mailing Address - State:MS
Mailing Address - Zip Code:38659-0088
Mailing Address - Country:US
Mailing Address - Phone:662-333-4333
Mailing Address - Fax:
Practice Address - Street 1:3 REIDS AVE
Practice Address - Street 2:
Practice Address - City:POTTS CAMP
Practice Address - State:MS
Practice Address - Zip Code:38659-8298
Practice Address - Country:US
Practice Address - Phone:662-333-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR861080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06879334Medicaid
MS500001955Medicare ID - Type UnspecifiedHEALTH 1ST
MS500002500Medicare ID - Type UnspecifiedHERNNADO
MSC03306Medicare ID - Type UnspecifiedCAHABA HEALTH 1ST
MSC03564Medicare ID - Type UnspecifiedCAHABA HERNANDO
MS06879334Medicaid