Provider Demographics
NPI:1952475642
Name:JESSOP, WILLIE MAE M (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:WILLIE
Middle Name:MAE M
Last Name:JESSOP
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:WILLIE
Other - Middle Name:MAE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6105 KAY BROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9660
Mailing Address - Country:US
Mailing Address - Phone:601-346-4303
Mailing Address - Fax:662-716-0689
Practice Address - Street 1:215 E 5TH STREET
Practice Address - Street 2:WOOLFOLK SCHOOL-BASED CLINIC GA CARMICHAEL FAMILY HEALT
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194
Practice Address - Country:US
Practice Address - Phone:662-716-0691
Practice Address - Fax:662-716-0689
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR107300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118259Medicaid
MS0118259Medicaid