Provider Demographics
NPI:1952477168
Name:STANTON, JENNIFER (CFNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFNP
Mailing Address - Street 1:4835 HIGHWAY 349 S
Mailing Address - Street 2:
Mailing Address - City:POTTS CAMP
Mailing Address - State:MS
Mailing Address - Zip Code:38659-9270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:602 BRUNSON DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4947
Practice Address - Country:US
Practice Address - Phone:662-680-3855
Practice Address - Fax:662-680-3372
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1952477168Medicaid