Provider Demographics
NPI:1780652362
Name:ADAMS, JODY T (CFNP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:T
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:587 HIGHWAY 51 STE T
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2567
Mailing Address - Country:US
Mailing Address - Phone:601-790-7711
Mailing Address - Fax:601-790-7712
Practice Address - Street 1:728 CLINTON PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5227
Practice Address - Country:US
Practice Address - Phone:601-200-4800
Practice Address - Fax:601-924-0473
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR688797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS753068151001OtherTRICARE
MS00124952Medicaid
MS753068151OtherMS HEALTH PARTNERS
MS753068151OtherMS PHYSICIANS CARE NETWOR
MS168390703OtherUS DEPT OF LABOR
MSP00062082OtherRR MEDICARE
MSP00062082OtherRR MEDICARE
MSS13739Medicare UPIN
MS500001362Medicare ID - Type Unspecified