Provider Demographics
NPI:1891400578
Name:BERKEY, JEANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:BERKEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 THORNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-7874
Mailing Address - Country:US
Mailing Address - Phone:601-394-9289
Mailing Address - Fax:
Practice Address - Street 1:1440 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4243
Practice Address - Country:US
Practice Address - Phone:601-428-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant